cardiac thoracic vascular trauma

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    Cardiac Thoracic & Vascular Trauma;Every Doctor should know

    Soebandrijo, Darmawan Ismail

    Sub Bag Bedah Toraks Kardiak & Vaskuler

    SMF. Ilmu Bedah FK UNS RSUD Dr MoewardiSurakarta

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    Apa yang anda lakukan?

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    Apa yang anda lakukan?

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    Apa yang anda lakukan?

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    Airway-Breathing & Vaskuler

    Airway

    Dada organ vital

    VaskulerThorak & kardiak

    Abdomen

    Pelvis

    Femur & fraktur di tempat lain

    Perdarahan eksternal

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    Deadly cases

    Airway obstruction

    Tension pneumothorax & sucking chestwound

    Massive hemothorax

    Tracheobronchial injury

    Flail chest

    Pericardial tamponade

    Laceration of vascular structure

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    How to diagnose?

    1. AirwayL: gerakan dada,

    L: suara nafas & ST,

    F: hembusan nafas

    2. BreathingL: tanda2 sesak, DVJ, gerakan dada paradoksal & tertinggal

    L: SD, ST

    F: Perkusi !! (palpasi krepitasi)

    3. CirculationL: anemis, cyanosis, DVJL: SJ, SJ menjauh

    F: akral dingin, CRT, nadi, tekanan darah

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    Airway obstruction

    Clinical finding

    Shortness of breath (dyspnea)

    Stridor

    Apnea

    Management Chin lift

    Jaw thrust

    Triple finger manuever

    Evacuate foreign body (cross finger)

    Hemlich manuver

    Cricothyroidostomy

    Tracheostomy

    ET insertion

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    Tension Pneumothorax

    Build up of air under

    pressure in the thorax.

    Excessive pressure

    reduces effectivenessof respiration

    Air is unable to escape

    from inside the pleural

    spaceProgression of Simple

    or Open Pneumothorax

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    Anx: Progressive shortness of breath

    PE :

    Pneumothorax percusion: hypersonor

    Neck vein distension (severe case)

    Treatment :

    Needle thoracocentesis

    Consult : chest tube insertion

    Tension Pneumothorax (simplify)

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    CXR image

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    Needle thoracocentesis

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    OPEN (SUCKING) CHEST WOUND

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    SUCKING CHEST WOUND

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    SUCKING CHEST WOUND

    Upon exhaling, air in

    the chest escapes

    through the flutter-typevalve created by taping

    3 sides only

    With inhaling, the patch

    should suck against theskin, preventing air

    entry

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    Hemothorax

    Hemothorax

    Accumulation of blood in the pleural space

    Serious hemorrhage may accumulate 1,500 mL of blood

    Mortality rate of 75%

    Each side of thorax may hold up to 3,000 mL

    MASSIVE (criteria)

    Blood loss in thorax causes a decrease in tidal volume

    Ventilation/Perfusion Mismatch & Shock

    Typically accompanies pneumothorax

    Hemopneumothorax

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    Blunt or penetrating chest

    trauma

    Shock

    Dyspnea Tachycardia

    Tachypnea

    Diaphoresis

    Hypotension

    Dull to percussion over injuredside

    Treatment

    Chest tube insertion & consult

    Hemothorax (simplify)

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    Trauma.org

    CXR Image

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    FLAIL CHEST

    PARADOXICAL RESPIRATIONS

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    Flail chest

    Multiple rib fractures produce a mobilefragment which moves paradoxically withrespiration

    Significant force required

    Usually diagnosed clinically

    Treatment

    ABCAnalgesia

    Fixation : internal &/ external

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    Flail Chest

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    Tracheobronchial Injury

    MOI

    Blunt trauma

    Penetrating trauma

    50% of patients with injury die within 1 hr of injury

    Disruption can occur anywhere in tracheobronchial tree

    Signs & Symptoms

    Dyspnea

    Cyanosis

    Hemoptysis

    Massive subcutaneous emphysema Crepitation

    Suspect/Evaluate for other closed chest trauma

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    Tracheobronchial Injury

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    Tracheobronchial Injury

    Observe for development of Subcutaneusemphysema & tension pneumothorax (deadly)

    Treatment

    Keep airway clear Administer high flow O2

    Consider intubation if unable to maintainpatient airway

    If tension needle thoracocentesis Consult : tracheal repair or tracheostomy

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    Restriction to cardiac filling caused by blood or other fluid

    within the pericardium

    Occurs in

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    Pericardial or CardiacPericardial or Cardiac tamponadetamponade

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    Dyspnea

    Possible cyanosis

    Becks Triad

    DVJ

    Distant heart tones

    Hypotension ornarrowing pulsepressure

    Weak, thready pulse

    Shock

    Pericardial Tamponade (simplify) Kussmauls sign

    Decrease or absence of

    JVD during inspiration

    Pulsus Paradoxus

    Drop in SBP >10 duringinspiration

    Due to increase in CO2

    during inspiration

    Electrical AlteransP, QRS, & T amplitude

    changes in every other

    cardiac cycle

    PEA

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    Pericardial Tamponade (ilustrations)

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    Laceration of vascular structures

    General sign

    Hypovolemia & shock

    Penetrating trauma (mostly)

    External bleeding

    Pemeriksaan teliti

    Balut tekan

    Torniquet

    Penjahitan

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    Laceration of vascular structures

    External bleeding

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    Uncontrolled bleeding or

    Massive vascular trauma victims

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    Laceration of vascular structures

    Internal bleeding Resusitasi cairanThoracic

    Px . Pada B (Chest XR)

    Abdominal Px: Cairan bebas dari peritoneum, berupa distensi, pekak

    alih & undulasi

    FAST (USG) or CT

    Pelvicum Px: distraction test, culdocentesis, floating prostat

    USG

    Femur Px: Expanding hematoma, Iskemia distal (XRay)

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    ATLS & ACLS

    Prinsip ABC

    Beda setting

    Contoh:

    saat berpidato atau main tenis tiba2 tak sadar,

    perawatan di RS tiba2 tak sadar

    Bisa simultan

    Contoh: pasien tua, trauma & mempunyai riw.Gangguan disritmia, kel: sesak nafas progresif dan

    kemudian cardiac arrest saat di UGD

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    Keterlambatan penangan akibat

    kurang waspada

    Kasus trauma dengan gangguan kesadaran

    Selalu ingat ABC, sblm D

    Kasus fraktur

    Selalu ingat NVD karena ada golden periode utk

    lesi vaskuler.

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    Always !!!

    PREPARE

    FORTHE WORST

    HOPEHOPEFOR THE BEST