trauma leher
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Trauma Leher
NOR/DNM
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Pendahuluan Kejadian : Semua kejadian trauma wajah dan dada harus dicurigai adanya trauma leher Keberhasilan penanganan trauma leher
sangat ditentukan oleh penanganan awal pasien datang
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Anatomi
Pertama kali diklasifikasikan menjadi 3 zona dalam naskah terbitan Monson et al Cook County Hospital 1969 Zone I clavicula sampai pada cricoid Zone II cricoid sampai pada angulus madibula Zone III Angulus mandibula sampai pada basis cranii
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Selected incisions used for classic radical neck dissection. A, Attie. B, Eckers and Byer. C, MacFee. D, Morestin. E, Conley. F, Latyshevsky and Freund. G, Martin. H, Z. I, Barbosa. (Modified from Strong EW. Radical neck dissection. In Nyhus LM, Baker RJ (eds). Mastery of Surgery, 2nd Ed. Boston: Little, Brown, 1992; with permission.)
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Zone I Trakea inferior dan esophagus Pembuluh darah dasar leher: Trunkus
brachiocephalica , arteri subclavia, arteri carotis communis, trunkus thyrocervicalis
ductus thoracicus glandula thyroid medula spinalis
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Zone II
laring, hypopharing arteri carotis communis arteri carotis interna dan externa vena jugularis interna nervus cranialis 10, 11, dan 12, medula spinalisZone III pharing arteri carotis arteri vertebralis vena jugularis interna
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Tipe trauma leher- Trauma tajam leherLuka tembakLuka tusuk
- Trauma tumpul leherKecelakaan kendaraan bermotorLuka karena olahragaTercekikPukulan
8
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McConnel paper combined data from 1963-1990 papers (2,495 pts)Kejadian trauma leher terbanyak pada aerodigestive (20%)diikuti trauma pada vena jugularis interna dan arteri carotis communis dan interna
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PENATALAKSANAANPENATALAKSANAAN Tujuan : Tujuan : establish on airwayestablish on airway
Tindakan penyelamat :Tindakan penyelamat :
- Airway (bebaskan jalan napas)- Airway (bebaskan jalan napas)
- Bleeding (hentikan perdarahan)- Bleeding (hentikan perdarahan)
- Circulation (bila syok - Circulation (bila syok atasi ) atasi )
- Exposure ( Ada tidaknya jejas )- Exposure ( Ada tidaknya jejas )
Pastikan multi trauma ?Pastikan multi trauma ?
fraktur tulang leher ?fraktur tulang leher ?
spinal cord injuriesspinal cord injuries ? ?
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intubasi atau cricothyrotomy Harus dianggap ada cervical spine injury
sampai terbukti sebaliknya
Trauma leher Zone I biasanya disertai trauma thorak pneumothorak hemopneumothorak tension pneumothorak
Luka tusuk hanya boleh diambil di OK.
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Didapatkan dari saksi atau pasien Mekanisme injuri Perkiraan blood loss Kemungkinan trauma thorax atau
abdominal Neurologic history
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Anamnesis Riwayat trauma Perubahan suara Dysphagia Odynophagia Kesulitan menelan Nyeri leher depan
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Pemeriksaan fisik Stridor Suara parau Emfisema subcutan Hemoptysis Kelemahan dan nyeri tekan laring,
ecchymosis, edema Kartilago thiroid tidak simetris luka vascular, cervical spine, esophagus Krepitasi
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Work up Lab :Cross-match, Darah Lengkap, Kimia
darah, UL, FH, BGA B-hCG untuk wanita Urine cath jika tidak ada kontra indikasi CXR Cervical spine Rx AP dan Lat Soft tissue neck films AP dan Lateral Arteriograms jika curiga trauma vaskuler
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Modalitas Laryngoscopy C-spine Rx CT scan Endoscopic Angiography dan contrast esophagograms Surgical Exploration
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Laryngoscopic Exam
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Indikasi CT Scan Trauma leher
dengan curiga ada frakture dan dislokasi laring
CT angiografi dilakukan jika curiga adanya cedera vaskular
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Emerg Med Austalasia
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Dr Íomhar O' Sullivan 23/06/2001. Cork Emergency Medicine 2013.
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Algoritma tata laksana trauma tajam leher
Mansour et al 1991 retrospective study
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Algorithm for evaluation of penetrating neck injuries. (From Demetriades D, Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, Velmahos G, Weaver F, Yellin A. Evaluation of penetrating
injuries of the neck: prospective study of 223 patients. World J Surg 1997;21:41-48; with permission.)
Algoritma Penetrating Neck Injury
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Penetrating neck injuries management guideline. GSW, gunshot wound; SW, stab wound; HVI, high-velocity injury; *, controversial approach. (From Britt LD, Cole FJ. "Alternative" surgery in trauma management. Arch Surg 1998, 133:1177-1181; with permission.)
Algoritma GSW, SW, HVI
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Zone I Sebelum naik ke OK kondisi pasien harus
benar-benar dipastikan karena tingkat kematian yang tinggi
Konsul kepada BTKV 4 vessel Angiography dianjurkan karena
mengidentifikasi cedera intraoperatif relatif susah
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Zone II
Sebagian besar carotid injury terjadi disini penelitian menunjukkan CT Angiografi Lebih
berguna dan sebanding dengan angiografi konvensional dalam evaluasi vaskular inj.
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Zone III Jika curiga ada cidera vaskuler dibutuhkan
CT angiografi segera Pharyngoscopy dilakukan untuk
menghilangkan curiga trauma aerodigestive
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Referensi
Boffard, D.K. Manual of Definitive Surgical Trauma Care 2nd Edition. 2007. Edward Arnold (Publishers) Ltd
John E. Skandalakis - Surgical Anatomy: The Embryologic And Anatomic Basis Of Modern SurgeryMcGraw-Hill Professional Publishing | 2004 | ISBN: 9603990744 | Pages: 1750 |