2_b_gangguan pernafasan.ppt
TRANSCRIPT
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Gangguan
Pernafasan
Bagian Anestesiologi dan ReanimasiFK Unsyiah RSUZA
Banda Aceh
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Breathing Evaluation
Look - chest movement, flaring nostrils,intercostal retraction
Listen - breath sound, abnormal sounds
Feel - air movement through mouth / nose
Palpation - chest movement, symmetrical?
Percussion - Damped?Hypersonor ?Symmetrical?
Auscultation (stethoscope) - Breath soundpresents? Symmetrical?
Resusitasi
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Signs of respiratory distress
Rapid shallow breathing
Flaring nostrils
Intercostal and neck
retraction
Rapid pulse
Hypotension
Distended neck veins
Cyanosis(late sign)
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B- breathing
1. Breathing? Normal breathing or
distressed?
2. Open chest wound? Sucking wound?
3. Tension pneumothorax?
4. Rib fractures? Multiple ? flail chest
5. Hemothorax?
6. Subcutaneous emphysema?
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Breathing? Normal breathing
or distressed?
No breath give
rescue breathing + O2
Gasping breath
give rescue breathing + O2
Rapid breathing > 25, flaring
nostrils, intercostal retraction give O2+ prepare rescue
breathing
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Open chest wound?
Sucking wound?
Penetrating chest wound
Sucking chest wound
Close the wound
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Open chest woundair enters pleural cavity
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Air enters pleural cavity
- from outside(stab wound)
- from insided(torn bronchi)
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A piece of plastic sheet
fix with adhesive tape on
3 sidesone way valve
to prevent pressure build-up
inside pleural cavity whileclosing the wound
previous method:
cover with sterile gauze
impregnated with vaselin
(risk of pressure build-up)
How to Cover Penetrating Chest Wound
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Tension Pneumothorax
Diagnosis by clinical signs only
Affected side will show
Palpation less chest expansion
Palpation of trachea shifts away to normalside
Percussion hypersonor (empty sound)
Auscultation reduced breath sound
Do needle thoracostomy,
do not wait for X-ray confirmation
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Palpate The Trachea at Sternal Notch
Look more
carefully for
pneumothorax inthe presence of
Rib fractures
Subcutaneousemphysema
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Needle Thoracostomy to Confirm Pneumothorax
(Needle and Filled Syringe System)
Bubble (+)= pneumothorax
Dont pull out the
needle until thoracic
drain is inserted
Bubble (-) and the
water was sucked
slowly inside
= no pnumothoraxPull needle out before
the syringe emptied
to avoid inducing
pneumothorax
lenght5 cm
water
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Rib fractures? Flail Chest ?4.
Inspiration Expiration
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Hemothorax?5.
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Subcutaneous EmphysemaFeels like grasping thin plastic sheet
Most caused by pneumothorax
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Artificial ventilation
12-20 x / minute, until chest rises
start ventilation to abnormal breathing, do not
delay until apnea occurs additional oxygen (if available)
if air enters the stomach, do not deflate by
pressing the epigastrium (risk of aspiration).Insert a nasogastric tube instead
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Artificial ventilation was provided along with in-line
immobilisation (hold the head and neck)
to prevent the neck from moving excessively
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Artificial ventilation via tracheal tube:1. More effective oxygenation and removal of CO2
2. Prevent pulmonary aspiration
3. No interruption of cardiac compression during CPR
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Any Question.
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T NKS