TRAUMA TAJAM

THORAX
Bebie Ayura 120100165
Durga A/P Alagindera 130100356

Jeeshnaavi A/P Muraleedharan 130100359

Roni Syaputra Hasibuan 140100064

Hakimah Hasan Lubis 150100079

Pembimbing :
dr. Brema Suranta Prakasa Utama Pasaribu, Sp. BTKV
Anatomi thorax
◸ Thorax dapat didefinisikan sebagai area yang dibatasi di superior
oleh thoracic inlet dan inferior oleh thoracic outlet; dengan batas
luar adalah dinding thorax yang disusun oleh vertebra torakal,
costae, sternum, muskulus, dan jaringan ikat.
◸ Rongga thorax dibatasi dengan rongga abdomen oleh diafragma.
Rongga thorax dapat dibagi ke dalam dua bagian utama, yaitu:
paru-paru (kiri dan kanan) dan mediastinum.
◸ Mediastinum dibagi ke dalam 3 bagian: superior, anterior, dan
posterior

2
 Rongga Thorax
• Dua kompartemen lateral “cavum pulmonal” yang terdiri dari
paru paru dan pleura
• Satu kompartemen sentral “mediastinum” yang terdiri dari :
jantung, pembuluh darah besar pars thorakalis, trakea pars
thorakalis, oesofagus, timus, dan struktur lainnya
3
 DEFINISI
Luka adalah hilang atau rusaknya sebagaian jaringan
tubuh. Keadaan ini dapat disebabkan oleh trauma
benda tajam dan tumpul, perubahan suhu, zat kimia,
ledakan, sengatan listrik atau gigitan hewan.

Jong, De dan Syamsuhidayat. 2011. Buku Ajar Ilmu Bedah. Jakarta. EGC.
Ariningrum, D., Subandono, J., Metria, I.D., Agustriani, N., et.al. 2018. Buku Manual Keterampilan Klinik Manajemen Luka. Kementrian Riset, Teknologi, dan Pendidikan Tinggi. Fakultas Kedokteran Universitas
Sebelas Maret. p.12.
 EPIDEMIOLOGI

 Insidensi dari trauma thorax di Amerika adalah 12 orang bagi setiap

1000 orang penduduk setiap harinya, dan 20-25% kematian disebabkan
oleh trauma adalah disebabkan trauma thorax.
 Trauma tembus thorax mencapai 1-13 % dari jumlah total trauma
thorax. 85% dari trauma tembus thorax ini dapat dikelola, baik dengan
observasi atau drainase pleura, sementara hanya 15-30% kasus
memerlukan intervensi bedah untuk trauma organ thorax yang dapat
berakibat fatal.

Christoporus, N. Handoyo., Supriyanto. 2018. Profil Trauma Thorax di Ruang Rawat Inap Bedah RSUD Gambiran. Jurnal Ilmiah Kedokteran. Wijaya Kesuma 7(2): 178-88.
Paci, M., Ferrari G., Annesi, V., et al. 2006. The Role Of Diagnostic VATS in Penetrating Thoracic Injuries. World J Emerg Surg. 1:30-31 .
PNEUMO
THORAX

01
DEFINISI

Pneumotoraks merupakan adanya udara di dalam rongga pleura yang

menyebabkan kolaps paru partial atau total.
 Tertutup / simple : dinding dada utuh dan udara masuk dari
permukaan paru-paru
 Terbuka: “sucking chest wound” udara masuk dari luka terbuka pada
dinding dada.
ETIOLOGI DAN KLASIFIKASI

Amboss.com. 2020. Pneumothorax – Knowledge For Medical Students And

Physicians. [online] Available at:
<https://www.amboss.com/us/knowledge/Pneumothorax> [Accessed 1
September 2020].
Amboss.com. 2020. Pneumothorax – Knowledge For Medical Students And Physicians. [online] Available at: <https://www.amboss.com/us/knowledge/Pneumothorax> [Accessed 1
September 2020].
 PATOGENESIS DAN MANIFESTASI KLINIS

Elliott, M., 2020. Tension Pneumothorax: Pathogenesis And Clinical Findings | Calgary Guide. [online] Calgaryguide.ucalgary.ca. Available at: <https://calgaryguide.ucalgary.ca/tension-
pneumothorax-pathogenesis-and-clinical-findings/> [Accessed 1 September 2020].
 DIAGNOSIS
• Pleuritic chest pain
• Dyspnea
History Taking • Tension pneumothorax = diaphoresis, cyanosis, weakness, symptoms oh
hypotension and cardiovascular collapse

• Tachypnea, tachycardia
Physical * Hiperresonance * Vocal fremitus (-)
• Tracheal deviation (tension pneumothorax)
Examination • Decreased breath sound

• Hypoxia, hypocapnia
Laboratorium • ECG = axis deviation, non specific ST segment changes, invertion of T wave

• Chest radiograph (PA and Lateral)

Imaging • CT scan

Doherty, G., 2015. Current Diagnosis & Treatment. 14th ed. New York: McGraw Hill, pp.350-352.
Jones, J., 2020. Pneumothorax (Summary) | Radiology Reference Article | Radiopaedia.Org. [online] Radiopaedia.org. Available at: <https://radiopaedia.org/articles/pneumothorax-
summary-1> [Accessed 1 September 2020].
 TREATMENT

2008. ATLS. 8th ed. Chicago, IL: American College of Surgeons, pp.88-89.
 ◸ Indications for surgical
intervention:
• Second ipsilateral pneumothorax
• First contralateral pneumothorax
• Bilateral spontaneous
pneumothorax
• Spontaneous hemothorax
• Risky professions (eg diver, pilot)
• Pregnant

◸ Definitive Therapy:
• Pleurectomy
• Pleurodesis
Truskett, P., 2014. Bailey and Love's Short Practice of Surgery; Edited by NS Williams, CJK Bulstrode and
PRO'Connell. Boca Raton, FL: CRC Press, 2013. Pp 855
HEMATO
THORAX

02
 HEMATOTHORAX
• Blood collection in the pleural space or as a pleural
fluid hematocrit is> 50%.
• Can come from the chest wall, intercostal blood
Definiton vessels, mammary internal arteries, large blood
vessels, mediastinum, myocardium, diaphragm /
abdominal pulmonary parenchyma.

• Traumatic thorax injuries (blunt/penetrating)

Etiology • Iatrogenic
• Spontaneous

• <400mL = Minimal
Classification • 400-1000mL = Medium
• >1000mL = Massive
Zeiler, J., Idell, S., Norwood, S., & Cook, A. (2020). Hemothorax. Clinical Pulmonary Medicine, 27(1), 1–12. doi:10.1097/cpm.0000000000000343 
 • Chest pain, dyspnea, mechanism of injury (falls, direction, and speed), drug /
alcohol use, comorbidities, history of surgery, and anticoagulation / antiplatelet
Histrory therapy.
Taking

• Respiratory distress, tachypnea, reduced or absent breath sounds, blunt

percussion, chest wall asymmetry, tracheal deviation, hypoxia, narrow pulse
pressure and hypotension.
Haemo
• Contusions, abrasions, "seat belt sign", penetrating injuries, paradoxical
dynamic
Respons movements ("flail chest"), ecchymosis, deformities, crepitus, and point
e ternderness

• Chest radiography
Imaging • Focal Assessment with Sonography in Trauma (FAST)
• Ct scan

Gomez, L.P. and Tran, V.H., 2019. Hemothorax. In StatPearls [Internet]. StatPearls Publishing.
Mancini, M., 2020. Hemothorax Workup: Approach Considerations, Laboratory Studies, Chest Radiography. [online] Emedicine.medscape.com. Available at:
<https://emedicine.medscape.com/article/2047916-workup#showall> [Accessed 1 September 2020].
 TREATMENT

◸ Initial resuscitation and management of trauma patients according to the

ATLS protocol.
◸ Tube thoracostomy
◸ Urgent anterior thoracotomy:
◸ 1500 ml of blood drainage in 24 hours via chest tube
◸ 300-500 ml / hour for 2 to 4 consecutive hours after insertion of the chest
tube
◸ Injury to large blood vessels or chest wall
◸ Pericardial tamponade

Gomez, L.P. and Tran, V.H., 2019. Hemothorax. In StatPearls [Internet]. StatPearls Publishing.
CARDIAC
TEMPONADE

03
DEFINISI

Mechanical compression of the heart by large amounts of fluid or blood

within the pericardial space.
ETIOLOGI
Gunshot/
stab
wounds

Blunt
pericarditis
trauma

Accidental
Ruptured
perforation
aortic
after cardiac
aneurysm
catheterization
SIGNS AND SYMPTOMS

Beck’s Other
Triad symptoms

Distance
Tachycardia
heart sound

Hypotension Dyspnoea

Distended Chest
jugular veins discomfort

Fatigue,
tiredness
DIAGNOSIS
Physical Other
History
Examinatio Examinatio
takings
n n
Chest pain Beck’s Triad Lab Test

Chest X-Ray
Palpitations Pulsus paradoxus
(Bottle shaped)

Shortness of ECG ( Sinus

Kussmaul sign
breath Tachycardia)

Tiredness /
Ewart Sign Echocardiography
dizziness
TREATMENT

Pericardiectomy
(Subxyphoid
pericardial window)

Pericardiocentesis Thoracotomy
THANKS!
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