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Dr.SOEBAGJO SpB.(K)TKV

BEDAH THORAX KARDIOVASKULER. Dr.SOEBAGJO SpB.(K)TKV. S 1. Thoracic trauma. Dr.SUBAGJO SpB(K)TKV 2.Thoracic trauma 1 out of 4 deaths blunt < 10% require operation. - penetrating 15% - require operation majority require Simple procedures. BEDAH THORAX. BEDAH JANTUNG

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Dr.SOEBAGJO SpB.(K)TKV

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  1. BEDAH THORAX KARDIOVASKULER Dr.SOEBAGJO SpB.(K)TKV

  2. S 1 Thoracic trauma Dr.SUBAGJO SpB(K)TKV 2.Thoracic trauma 1 out of 4 deaths blunt < 10% require operation. - penetrating 15% - require operation majority require Simple procedures

  3. BEDAH THORAX • BEDAH JANTUNG • BEDAH NON JANTUNG / PARU

  4. PEMERIKSAAN PRA BEDAH • FAAL PARU • BRONCHOSCOPY • BRONCHOGRAFI • CT SCAN • FOTO THORAX • FAAL HEPAR, GINJAL, HEMOSTASISD • FNA/TTB : TRANSTORAKAL BIOPSI

  5. TRAUMA ANAMNESA PEMERIKSAAN FISIK - INSPEKSI - PALPASI - PERKUSI - AUSKULTASI PEMERIKSAN TAMBAHAN : FOTO X RAY

  6. IDENTIFIKASI AWAL (PRIMARY SURVEY) • SUMBATAN AIRWAY • TENSION PNEUMOTHORAX • OPEN PNEUMOTHORAX • FLAIL CHEST • HEMOTHORAX MASIF • TAMPONADE JANTUNG

  7. Ilustrasi

  8. Thoracic trauma • - 1 out of 4 death • - blunt < 10 % require operation • - penetrating 15%-30% require operation • - majority require simple procedures

  9. PRIMARY SURVEY/LIFE – THREATENING INJURIES MAJOR PROBLEMS SHOULD BE CORRECTED AS THEY ARE IDENTIFIED- airway obstruction- tension pneumothorax- open pneumothorax- flail chest- massive hemothorax- cardiac tamponade

  10. AIRWAY OBSTRUCTION laryngeal injury • - rare occurrence • - hoarseness • - subcutaneous emphysema • - treatment * intubation * tracheostomy

  11. BREATHING • TENSION PNEUMOTORAX : Etiology • Parenchymal and/or chest-wall injury. • Air enters pleural space with no exit • Positive pressure ventilation - collapse of affected lung - decrease venous return - decrease ventilation of opposite lung.

  12. BREATHING Tension pneumothorax sign/symptoms • respiratory distress • Distended neck veins • Unilateral decrease in breath sounds • Hyperresonance • Cyanosis, late

  13. BREATHING TENSION PNEUMOTHORAX • immidiate decompression • Clinical diagnosis, not by X ray Therapy : nedlee decompression and chest tube after it has been inserted

  14. BREATHING 2.Open pneumothorax • cover defect • Chest tube • definitive operation

  15. 3. BREATHING FLAIL CHEST /PULMONARY CONTUSION • Reexpand lung • Oxygen • Judicous fluid management • Intubation as indicated • analgesia

  16. FLAIL CHEST • Terapi definitif  ditujukan pada pengembangan paru, oksigenasi, cairan yang cukup serta analgesia • Tekanan oksigen arterial dan kinerja pernafasan, penilaiannya menentukan kapan diberi intubasi dan ventilasi

  17. 4.CIRCULATION MASSIVE HEMOTHORAX : • > 1500 ml blood loss • Systemic/pulmonary vessel disruption • Flat vs distended neck veins • Shock with no breath sound and/or percussion dullness

  18. CIRCULATION MASSIVE HEMOTHORAX • rapid volume restoration • chest decompression and X-ray • autotransfusion • operative intervention :

  19. CIRCULATION CARDIAC TAMPONADE • decrease arterial pressure • distended neck veins • muffled heart sound • PEA THERAPY – patent airway - iv therapy - pericardiocentesis - pericardiostomy

  20. SECONDARY SURVEYPOTENTIALLY LETHAL CHEST TRAUMA • SIMPLE PNEUMOTHORAX • HEMOTHORAX • PULMONARY CONTUSION • TRACHEOBRONCHIAL TREE INJURIES • BLUNT CARDIAC INJURY • TRAUMATIC AORTIC DISRUPTION • TRAUMATIC DIAPHRAGMATIC INJURY • MEDIASTINAL TRANSVERSING WOUNDS

  21. 1.SIMPLE PNEUMOTHORAX • penetrating/blunt trauma • hyperresonance • decrease breath sounds • tube thoracostomy

  22. 2.HEMOTHORAX • chest wall injury • lung/vessel laceration • tube thoracostomy

  23. 3.PULMONARY CONTUSION • Most common • Oxygenate ventilate • Selective intubation

  24. 4.TRACHEAL INJURY • Frequently missed injury • Blunt/penetrating trauma • Partial vs complate • Diagnostic aid endoscopy • Treatment * airway ventilation * operation

  25. 5.BLUNT CARDIAC INJURY • Injury spectrum • ECG changes: monitor change • Echocardiography • Tret dysrhytmiaa, Q complications

  26. 6.AORTIC RUPTURE • Rapid aceleration/deceleration • Ligamentum arteriosum • Salvage identify early • Surgical consult • X-ray: widened mediastinum,obliteration of the aortic knob,depression of the left main stem bronchus,fractures of the first or second rib or scapula • Aortogram. • Therapy  primer suture aorta / resection and grafting

  27. 7.DIAPHRAGMATIC RUPTURE - most diagnosted on left - blunt , large tears - penetrating, small perforations - misinterpreted x ray (elevated diaphragm,acute gastric delatation, aloculated pneumothorax - contras radiography • Therapy  direct closure

  28. 8.MEDIASTINAL TRANSVERSING WOUNDhemodinamically abnormal • exsanguinating thoracic hemorrhage • tension pneumothorax • Pericardial tamponade • Esophageal or tracheobronchial injury • Spinal cord injury hemodinamicallynormal - vascular: angiography • tracheobronchial: bronchoscopy • esophageal: esophagography,esophagoscopy • Treatment  mandatory surgical consultation, repair identified injuries,

  29. OTHERS TRAUMA TRAUMATIC ASPHYXIA • Ptechiae • Swelling • Plethora • Cerebral edema

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