cardiac thoracic vascular trauma

8/12/2019 Cardiac Thoracic Vascular Trauma

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Cardiac Thoracic & Vascular Trauma;Every Doctor should know

Soebandrijo, Darmawan Ismail

Sub Bag Bedah Toraks Kardiak & Vaskuler

SMF. Ilmu Bedah FK UNS RSUD Dr MoewardiSurakarta


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Apa yang anda lakukan?


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Airway-Breathing & Vaskuler

Airway

Dada organ vital

VaskulerThorak & kardiak

Abdomen

Pelvis

Femur & fraktur di tempat lain

Perdarahan eksternal


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Deadly cases

Airway obstruction

Tension pneumothorax & sucking chestwound

Massive hemothorax

Tracheobronchial injury

Flail chest

Pericardial tamponade

Laceration of vascular structure


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How to diagnose?

1. AirwayL: gerakan dada,

L: suara nafas & ST,

F: hembusan nafas

2. BreathingL: tanda2 sesak, DVJ, gerakan dada paradoksal & tertinggal

L: SD, ST

F: Perkusi !! (palpasi krepitasi)

3. CirculationL: anemis, cyanosis, DVJL: SJ, SJ menjauh

F: akral dingin, CRT, nadi, tekanan darah


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Airway obstruction

Clinical finding

Shortness of breath (dyspnea)

Stridor

Apnea

Management Chin lift

Jaw thrust

Triple finger manuever

Evacuate foreign body (cross finger)

Hemlich manuver

Cricothyroidostomy

Tracheostomy

ET insertion


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Tension Pneumothorax

Build up of air under

pressure in the thorax.

Excessive pressure

reduces effectivenessof respiration

Air is unable to escape

from inside the pleural

spaceProgression of Simple

or Open Pneumothorax


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Anx: Progressive shortness of breath

PE :

Pneumothorax percusion: hypersonor

Neck vein distension (severe case)

Treatment :

Needle thoracocentesis

Consult : chest tube insertion

Tension Pneumothorax (simplify)


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CXR image


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Needle thoracocentesis


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OPEN (SUCKING) CHEST WOUND


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SUCKING CHEST WOUND


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SUCKING CHEST WOUND

Upon exhaling, air in

the chest escapes

through the flutter-typevalve created by taping

3 sides only

With inhaling, the patch

should suck against theskin, preventing air

entry


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Hemothorax

Hemothorax

Accumulation of blood in the pleural space

Serious hemorrhage may accumulate 1,500 mL of blood

Mortality rate of 75%

Each side of thorax may hold up to 3,000 mL

MASSIVE (criteria)

Blood loss in thorax causes a decrease in tidal volume

Ventilation/Perfusion Mismatch & Shock

Typically accompanies pneumothorax

Hemopneumothorax


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Blunt or penetrating chest

trauma

Shock

Dyspnea Tachycardia

Tachypnea

Diaphoresis

Hypotension

Dull to percussion over injuredside

Treatment

Chest tube insertion & consult

Hemothorax (simplify)


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Trauma.org

CXR Image


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FLAIL CHEST

PARADOXICAL RESPIRATIONS


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Flail chest

Multiple rib fractures produce a mobilefragment which moves paradoxically withrespiration

Significant force required

Usually diagnosed clinically

Treatment

ABCAnalgesia

Fixation : internal &/ external


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Flail Chest


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Tracheobronchial Injury

MOI

Blunt trauma

Penetrating trauma

50% of patients with injury die within 1 hr of injury

Disruption can occur anywhere in tracheobronchial tree

Signs & Symptoms

Dyspnea

Cyanosis

Hemoptysis

Massive subcutaneous emphysema Crepitation

Suspect/Evaluate for other closed chest trauma


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Observe for development of Subcutaneusemphysema & tension pneumothorax (deadly)

Treatment

Keep airway clear Administer high flow O2

Consider intubation if unable to maintainpatient airway

If tension needle thoracocentesis Consult : tracheal repair or tracheostomy


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Restriction to cardiac filling caused by blood or other fluid

within the pericardium

Occurs in


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Pericardial or CardiacPericardial or Cardiac tamponadetamponade


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Dyspnea

Possible cyanosis

Becks Triad

DVJ

Distant heart tones

Hypotension ornarrowing pulsepressure

Weak, thready pulse

Shock

Pericardial Tamponade (simplify) Kussmauls sign

Decrease or absence of

JVD during inspiration

Pulsus Paradoxus

Drop in SBP >10 duringinspiration

Due to increase in CO2

during inspiration

Electrical AlteransP, QRS, & T amplitude

changes in every other

cardiac cycle

PEA


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Pericardial Tamponade (ilustrations)


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Laceration of vascular structures

General sign

Hypovolemia & shock

Penetrating trauma (mostly)

External bleeding

Pemeriksaan teliti

Balut tekan

Torniquet

Penjahitan


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External bleeding


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Uncontrolled bleeding or

Massive vascular trauma victims


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Internal bleeding Resusitasi cairanThoracic

Px . Pada B (Chest XR)

Abdominal Px: Cairan bebas dari peritoneum, berupa distensi, pekak

alih & undulasi

FAST (USG) or CT

Pelvicum Px: distraction test, culdocentesis, floating prostat

USG

Femur Px: Expanding hematoma, Iskemia distal (XRay)


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ATLS & ACLS

Prinsip ABC

Beda setting

Contoh:

saat berpidato atau main tenis tiba2 tak sadar,

perawatan di RS tiba2 tak sadar

Bisa simultan

Contoh: pasien tua, trauma & mempunyai riw.Gangguan disritmia, kel: sesak nafas progresif dan

kemudian cardiac arrest saat di UGD


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Keterlambatan penangan akibat

kurang waspada

Kasus trauma dengan gangguan kesadaran

Selalu ingat ABC, sblm D

Kasus fraktur

Selalu ingat NVD karena ada golden periode utk

lesi vaskuler.


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Always !!!

PREPARE

FORTHE WORST

HOPEHOPEFOR THE BEST

cardiac thoracic vascular trauma

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