Chest Trauma (pedoman trauma tugas belajar)

study shared

1. 13 April 2019

2. PURPOSE
•To be able identifying chest trauma case
•To recognize the early signs and symptoms of
life threatening injuries in chest trauma case
•To be able managing chest trauma case in pre-
hospital setting

3. 3
A B

4. 4
C D

5. 5
E F

6. 6
Approximately 2/3 of the patients have a chest trauma
with varying severity from a simple rib fracture to
penetrating injury of the heart
or tracheobronchial disruption.
Blunt chest trauma is most common
with 90% incidence, of which
less than 10% require surgical intervention of any kind.
Mortality is second highest after head injury,
which underlines the importance of initial management.
Many of these deaths can be prevented by prompt
diagnosis and treatment.
Male,43 yo, single motorcycle
accident, complaint of right chest
pain, alert, BP 110/60 mmHg, HR 86
bpm, RR 26 x/min, Temp 36.8° C,
SaO2 94%
Trauma is the leading cause of death worldwide.

7. PRIMARY SURVEY
•Airway: secure a viable airway!!!
•Breathing: ensure presence of breath sounds and
adequate minute ventilation
•Circulation: establish 2 large bore IVs and stop any
significant bleeding
•Disability: recognize and stabilize any injuries
outside the chest
•Early chest X-ray

8. After a primary survey, immediately
life-threatening injuries should be
excluded or treated such as:
•Airway obstruction
•Tension pneumothorax
•Open pneumothorax
•Massive haemothorax
•Intercostal disruption / Flail chest
•Cardiac tamponade

9. 9
AIRWAY OBSTRUCTION
•Should be assumed in ALL TRAUMA PATIENTS
•Objective signs: agitation, obtunded, cyanosis, abnormal breath
sound and deviated trachea.
•Brief airway assessment prior to definitive airway management
•Simple techniques : jaw thrust maneuver, OPA, NPA
•Compromised → definitive airway management
•Selection of airway device → injury, experience and skill level

10. 10
TENSION PNEUMOTHORAX
•Anxiety, agitation,
apprehension
•Distended Jugular Vein
•Tracheal deviation
•Diminished or absent breath
sounds
•Hyper resonance
•Increased dyspnea with
cyanosis → SHOCK
•Immediate needle decompression
•large bore needle at 2
nd
intercostal
space, mid- clavicular line
•Chest tube (definitive treatment)

11. 11
OPEN PNEUMOTHORAX
•Tachycardia, tachypnea
•Restlessness
•Chest wall defect
•Impaled object
•Sucking chest wound
•Bubbling wound
•Subcutaneous emphysema
•High flow O
2
•Cover site with sterile
occlusive dressing
tape on 3 sides
•Progressive airway
management if
indicated

12. 12
MASSIVE HAEMOTHORAX
•Accumulation of > 1.5 L of blood
•Neck veins flat
•Absent breath sounds
•Dull to percussion
•Disruption of large vessel
•Shock
•Chest tube in 5
th
space
•Fluid resuscitation
•Thoracotomy

13. 13
FLAIL CHEST
•3 or more ribs are broken in
at least 2 places
•extremely painful
•Paradoxical movement
•Adequate ventilation with oxygen
•Non-invasive ventilation when possible, invasive only when others failed and
extubation should be attempted as early as possible
•Fluid management
•Pain management → early and aggressively, nerve blocks or epidural anesthesia
•Management of the unstable chest wall
•Excellent pulmonary toilet
•Internal pneumatic stabilization
•Avoid steroids

14. 14
CARDIAC TAMPONADE

15. Head to toe examination
Will provide information on potentially life- threatening
injuries:
•Pulmonary contusion
•Myocardial contusion
•Aortic disruption
•Traumatic diaphragmatic rupture
•Tracheobronchial disruption
•Esophageal disruption
SECONDARY SURVEY

16. PRE-HOSPITAL TRAUMA
LIFE SUPPORT
•Assessment of breathing, respiratory movements and
quality of respiration
•Inspection, palpation, percussion and especially
auscultation
•Treated as needed:
•Oxygen supplementation
•Fluid management
•Pain management
•Immediate needle decompression for tension pneumothorax
•3-sided tape for open pneumothorax, etc.
•Repeated examination and observation
•Refer to appropriate hospital with adequate transportation

17. Thank you
•https://msrc.internationalsos.com/LearningCenter/EmergencyResponseDrills/Mart
in%20Botha.pdf#search=chest%20trauma
•https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392544/
•https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237145/
•https://www.ncbi.nlm.nih.gov/books/NBK534090/