Escolar Documentos
Profissional Documentos
Cultura Documentos
Andanu Indratnoto
14 Desember 2011
RSAL Dr.Mintohardjo
Jakarta
ATLS :
ATLS :
Thoracic trauma
● Significant cause of mortality
● Blunt: < 10% require operation
● Penetrating: 15-30% require operation
● Majority: Require simple procedures
● Most life-threatening injuries are identified
during the primary survey
Primary survey-Secondary survey
DEFINITIVE CARE
RE-EVALUATION
X-rays : Cervical
Thorax DEFINITIVE
Pelvis CARE
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Thorax :
1.Laryngeotracheal injury/Airway obstruction
2.Tension pneumothorax Thorax : 1.Tracheobronchial tree injury
3.Open pneumothorax 2.Simple pneumothorax
3.Pulmonary contusion
4.Flail cheast + pulmonary contusion 4.Hemothorax
5.Massive hemothorax 5.Blunt cardiac injury
6.Traumatic aortic disruption
6.Cardiac tamponade 7.Blunt esophegeal injury
8.Traumatic diaphragmatic injury
Primary surveyBreathing :
• Pathophysioligic consequencec of these chest
injuries : Hypoxia Hyperventilation
Acidosis Respiratory/Metabolic
“Inadequate tissue perfusion”
• Manage in the primary survey as identified
Laryngeotracheal injury
• Airway obstruction Early
assessment + recognition of
the need for establishing a
controlled airway while
maintaining in-line
immobilization of cervical
spine at all times
Laryngeotracheal injury
Carina Esophagus
Trachea
Tension Pneumotorax
• Clinical diagnosis
decreased breath sounds +
hyperresonance
immedate decompression
of the pleural space
Right tension
pneumothorax
Mediastinal shift
Tension Pneumothorax
1.Pneumothorax
3.Mediastinal
shift
4.Vena cava
2.Collapsed
lung
Non hemorragic shock
Chest tube
Intercostal space 5.
Open Pneumothorax
• Obvious chest wall
deformity with sucking
chest wound is initially
managed with flutter-
valve dressing
Flutter-valve dressing
Bolin-chest-seal
Flail Chest + Pulmonary Contusion
• Unstable segment of chest
wall with paradoxical
motion requires judicious
fluid resuscitation and
adequate analgesia with
selective intubation for
pulmonary support
Flail Chest + Pulmonary Contusion
Flail Chest
Flail Chest
Paradoxal
Massive Hemothorax
• Diagnosed by finding decreased
breath sounds and dullness to
percussion on physical examination
• Initial management requires
evacuation with insertion of large (#
36 French) chet tube
• A qualified surgeon must be
involved in the decision for
thoracotomy
Blood
Pleural space
Massive Hemothorax
Massive
hemothorax
Cardiac Tamponade
• Diagnosis by clinical
examination, with ultrasound
examination to confirm
• Initial management includes
fluid resuscitation and surgery
• Pericardiocentesis may used
as a temporizing maneuver if
surgical intervention is not
immediately available
Secondary surveyThorax :
• Identification + initial treatment, utilizing
adjunctive studies x-rays, laboratory test,
ECG.
Tracheobronhial tree injury
Simple
pneumothorax
Pulmonary contusion
• Typically diagnosed by chest x-ray or CT scan
• Management includes judicious fluid
resuscitation and selective intubation for
pulmonary support
Hemothorax
• Typically diagnosed by chest x-ray or CT scan
• Treated with tube thoracostomy
Right
hemothorax
Left Hemothorax
Chest tube
Blunt cardiac trauma
• Most common complication is arrhythmias,
which are managed according to standard
protocols
• Less common complications include acute
myocardial infarction and valvular disruption
Hemopericardium
Blunt cardiac trauma : CT scan
Traumatic aortic disruption
Aortic rupture
• Early diagnosis requires a
high index of suspicion
• Most common radiographic
sign is widened mediastinum
seen on anteroposterior
chest x-ray Pulmonary artery
• Diagnosis is confirmed by
dynamic helical CT
Left atrial oracle
scanning/aortography
• Qualified surgeon must be
involved in management
Blunt esophageal injury
• Physical examination reveals pain out of
proportion for injuries
• Associated with left pleural effusion and/or
pneumomediastinum
• Early operative intervention by a qualified
surgeon reduces morbidity and mortality
No fractures or pneumothorax
Peneumomediatinum
Subcutaneus emhysema
Traumatic diaphragmatic injury
• Commonly on the left side
• Frequently missed initially in chest
film
•
• Treatment is by direct repair
• Early diagnosis requires a high Diaphragmatic hernia
index of suspicion
• Most common radiographic sign is
elevation of diaphragma on side
• Requires early laparotomy for
repair and to address associated
injuries
Traumatic diaphragmatic injury
Traumatic diaphragmatic
Diaphragmatic rupture
Diaphragmatic
rupture
Subcutaneus emphysema
• Is associated with airway or
lung injury
• Tube thoracostomy
patients requiring positive
pressure ventilation
Subcutaneus
emphysema
Crush injury of the chest
• Petechiae and plethora of the head,neck and
upper torso
• Suspected brain injury with progressive
cerebral edema
Summary
• Primary survey Life threatening chest
injuries
• Secondary survey Potential life threatening
chest injuries
Thank you