ctv for drmuda

8/16/2019 Ctv for Drmuda

1/27

PROGRAM CO-ASSISTEN STASEBEDAH TKV

Sub Bagian Bedah Thorak KardioVaku!er

RSUD Dr Muwardi – Fakultas Kedokteran UNS

Surakarta


2/27

3 Day Program

– 1st day• Diskusi materi dasar BTK ! "mergen#y

• Men#ari kasus yg menarik di ruangan la$orresiden%konsulen ! &uat status

– 'nd • Melan(utkan diskusi

• Diskusi kasus % kalo tidak ada kasus) $akai metode*$+antom,

• isite -&ed side tea#+ing.

– 3rd • Melan(utkan diskusi utk menam&a+ nilai (ika di$erlukan

• Mem&a+as kasus BTK yang menarik -&a+an darikonsultan) residen atau #o ass.


3/27

Penilaian

• Selama diskusi $enilaiankemam$uan kogniti/ ! sika$) sesuai*/ormulir mini,

• isite -&ed side tea#+ing. $enilaian ketram$ilan ! sika$)sesuai */ormulir mini,

• Keakti/an dalam diskusi

• Penulisan la$oran kasus -kelom$ok.


4/27

Materi Dasar Beda+ TK

• Pemeriksaan 0sik• Pemeriksaan k+usus BTK -ari#es !

arterial in(ury.

•

2wal resusitasi ! BS• 4+est 5R

• 6SD

• Penyakit 7antung Koroner

• Penyakit 7antung Bawaan

• Tumor regio T+oraks


5/27

Kaida+ Dalam *"mergen#y,

18 2B4

'8 F

38 Diagnosti# #e$at ! te$at

98 Penatalaksanaan te$at

1. Life saving

2. Denitive

38 Pemeriksaan $enun(ang98 Meru(uk

:8 ;&serasi ! ealuasi


6/27

ook – isten < Feel

18 2irway

= gerakan dada)

= suara na/as ! ST)

F= +em&usan na/as

'8 Breat+ing= tanda' sesak) D7) gerakan dada $aradoksal !

tertinggal

= SD) ST

F= Perkusi >>38 4ir#ulation

= anemis) #yanosis) D7

= S7) S7 men(au+

F= akral dingin) 4RT) nadi) tekanan dara+


7/27


8/27

42RD@; TA;R24@4 2S4U2R

SUR"RC-Basi# Knowledge ! Skill.

For @nterns+i$ Program

UNS Medi#al Fa#ulty – Dr Moewardi

Aos$ital

Surakarta


9/27

• Blunt Trauma – Results /rom kineti# energy /or#es – Su&diision Me#+anisms

• Blast – Pressure wae #auses tissue disru$tion – Tear &lood essels ! disru$t aleolar tissue – Disru$tion o/ tra#+eo&ron#+ial tree – Traumati# dia$+ragm ru$ture

• 4rus+ -4om$ression. – Body is #om$ressed &etween an o&(e#t and a +ard sur/a#e – Dire#t in(ury o/ #+est wall and internal stru#tures

• De#eleration – Body in motion strikes a 0?ed o&(e#t

– Blunt trauma to #+est wall – @nternal stru#tures #ontinue in motion

» Ligamentum Arteriosum s+ears aorta

– 2ge Fa#tors• Pediatri# T+ora?= More #artilage 2&sor&s /or#es• eriatri# T+ora?= 4al#i0#ation ! osteo$orosis More /ra#tures

Pat+o$+ysiology o/ Trauma


10/27

Pat+o$+ysiology o/ Trauma

• Penetrating Trauma – ow "nergy

• 2rrows) knies) +andguns

•

@n(ury #aused &y dire#t #onta#t and #aitation – Aig+ "nergy

• Military) +unting riEes ! +ig+ $owered +and guns

• "?tensie in(ury due to +ig+ $ressure #aitation


11/27

@n(uries 2sso#iated wit+4ardio T+ora#i# as#ular Trauma

• Airway obstruction

• 4losed $neumot+ora?

• ;$en $neumot+ora?-sucking chest wound .

• Tension pneumothorax

• Pneumomediastinum

• Hemothorax

(massive)• Aemo$neumot+ora?

• Rib fracture (ailchest)

• Tracheobronchialtree lacerations(rupture)

• "so$+ageal

la#erations• Penetrating #ardia#

in(uries

• ericardialtamponade

• S$inal #ord in(uries

• Dia$+ragm trauma

• @ntra


12/27


13/27

2irway o&stru#tion

• 4lini#al 0nding – S+ortness o/ &reat+ -dys$nea.

– Stridor

– 2$nea

• Management – 4+in li/t

– 7aw t+rust

– Tri$le 0nger manueer

–

"a#uate /oreign &ody – Aemli#+ manuer

– "T insertion

– 4ri#ot+yroidostomy

– Tra#+eostomy


14/27

D;NT F;R"T

4"R@42 SP@N"4;NTR; >>>>


15/27

Tension Pneumot+ora?

– Build u$ o/ air under$ressure in t+et+ora?8

– "?#essie $ressure

redu#es eGe#tienesso/ res$iration

– 2ir is una&le toes#a$e /rom inside

t+e $leural s$a#e – Progression o/ Sim$le

or ;$enPneumot+ora?


16/27

• 2n?= Progressie s+ortness o/ &reat+

• P" = – Pneumot+ora? $er#ution= +y$ersonor

– Ne#k ein distension -seere #ase.

• Treatment = – Needle t+ora#o#entesis

– 4onsult = #+est tu&e insertion

Tension Pneumot+ora? -sim$li/y.


17/27

SU4K@N 4A"ST 6;UND

• U$on e?+aling) airin t+e #+est

es#a$es t+roug+

t+e Eutter


18/27

Aemot+ora?

• Aemot+ora? – 2##umulation o/ &lood in t+e $leural s$a#e

– Serious +emorr+age may a##umulate 1):HH mo/ &lood• Mortality rate o/ I:J

• "a#+ side o/ t+ora? may +old u$ to 3)HHH m

• M2SS@" -#riteria.

– Blood loss in t+ora? #auses a de#rease in tidal

olume• entilation%Per/usion Mismat#+ ! S+o#k

– Ty$i#ally a##om$anies $neumot+ora?• Aemo$neumot+ora?


19/27

• Blunt or $enetrating#+est trauma

• S+o#k – Dys$nea

– Ta#+y#ardia

– Ta#+y$nea

– Dia$+oresis

– Ay$otension

• Dull to $er#ussion oerin(ured side

• Treatment4+est tu&e insertion !

#onsult

Aemot+ora? -sim$li/y.


20/27

Flail #+est

• Multi$le ri& /ra#tures $rodu#e a mo&ile/ragment w+i#+ moes $arado?i#allywit+ res$iration

• Signi0#ant /or#e reuired

• Usually diagnosed #lini#ally

• Treatment – 2B4 – 2nalgesia

– Fi?ation = internal !% e?ternal


21/27

Tra#+eo&ron#+ial @n(ury

– M;@• Blunt trauma

• Penetrating trauma

– :HJ o/ $atients wit+ in(ury die wit+in 1 +r o/ in(ury

– Disru$tion #an o##ur anyw+ere in tra#+eo&ron#+ial tree

– Signs ! Sym$toms• Dys$nea

• 4yanosis

• Aemo$tysis

• Massie suutaneous em$+ysema

• Sus$e#t%"aluate /or ot+er #losed #+est trauma


22/27

Tra#+eo&ron#+ial @n(ury

• ;&sere /or deelo$ment o/Suutaneus em$+ysema !tension $neumot+ora? -deadly.

• Treatment• Kee$ airway #lear• 2dminister +ig+ Eow ;'• 4onsider intu&ation i/ una&le to

maintain $atient airway• @/ tension needle

t+ora#o#entesis• 4onsult = tra#+eal re$air or

tra#+eostomy


23/27

– Restri#tion to #ardia# 0lling #aused &y &lood orot+er Euid wit+in t+e $eri#ardium

– ;##urs in L'J o/ all serious #+est trauma• Aoweer) ery +ig+ mortality

– Results /rom tear in t+e #oronary artery or$enetration o/ myo#ardium• Blood see$s into $eri#ardium and is una&le to es#a$e

• 'HH


24/27

• Dys$nea• Possi&le #yanosis

• Be#ks Triad

– D7

– Distant +eart tones – Ay$otension or

narrowing $ulse$ressure

• 6eak) t+ready $ulse

• S+o#k

Peri#ardial Tam$onade -sim$li/y.•

Kussmauls sign – De#rease or

a&sen#e o/ 7Dduring ins$iration

•

Pulsus Parado?us – Dro$ in SBP 1H

during ins$iration

– Due to in#rease in

4;' duringins$iration

• "le#tri#al 2lterans

– P) RS) ! Tam$litude #+angesin eery ot+er


25/27

Peri#ardial Tam$onade-ilustrasi.


26/27

a#eration o/ as#ularstru#tures

• eneral sign – Ay$oolemia ! s+o#k

– Penetrating trauma

• @nternal &leeding – T+ora#i# 4+est 5R

– 2&dominal F2ST or 4T

– Peli#um 45R

– Femur e?$anding +ematoma O 5R

• "?ternal &leeding t+oroug+ e?amination! suturing


27/27

a#eration o/ as#ularstru#tures

• @nternal &leeding #onsult

• "?ternal &leeding

ctv for drmuda

Documents