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Referat Hemothoraks

hemothoraks

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238 views28 pages

Referat Hemothoraks

hemothoraks

Uploaded by

itsmedi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Pembimbing : dr. Amran Sinaga, Sp.

HEMATOTHORAKS
- Diah Media Rizki -

FKIK UNIVERSITAS JAMBI


Profesi Dokter
1
Anatomy (1 of 3)
• Ribs
–12 pairs
• 10 pairs attach to sternum and spine
• 2 pairs (floating ribs) attach only in back

–An intercostal nerve, artery, and vein


are found along the inferior border of
each rib
Anatomy (2 of 3)
• Lungs
• Mediastinum
– Heart
– Major arteries
• Aorta and branches
• Pulmonary arteries
– Veins
• Superior vena cava
• Pulmonary veins

• Trachea
• Esophagus
• Main bronchi
Anatomy (3 of 3)
• Mediastinum
Physiology of Life Review
• Oxygen is transported across the alveolar–capillary membrane
• It then attaches to hemoglobin in red blood cells for transport to the
rest of the body
• At the same time, CO2 moves from the
blood plasma into the alveoli
• Respiratory Function :
• 1. Ventilation : inspiration and ekspiration
• 2. Distribution : Air flow evenly throught the airway until the alveoli
• 3. Difution : Gas exchange O2 and CO2

• Any failure or obstacle of the chain of such mechanism will cause


interference with respiratory function,
Breathing
• The mechanical act of moving air into the lungs

and alveoli

• Controlled by the respiratory center of the brain

• Chemoreceptors located in the aorta and carotid arteries stimulate


the respiratory center

• Rate and depth of ventilation are continuously adjusted to maintain


normal PaCO2 levels
Breathing Assessment (1 of 6)
• Look (observe)

• Listen (auscultate)

• Feel (palpate)
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Breathing Assessment (2 of 6)
• Look (observe)

– Increased respiratory effort

• Positioning

• Use of accessory muscles

• Retractions
Courtesy of Health Resources and Services Administration, Maternal and Child

• Nasal flaring in children


Health Bureau, Emergency Medical Service for Children Program
Breathing Assessment (3 of 6)
• Look (observe) (cont’d)
– Visible signs of trauma
• Contusions
• Hematomas
• Lacerations
• Sucking chest wound
• Paradoxical movement
of the chest wall
Breathing Assessment (4 of 6)
• Listen (auscultate) for breath sounds

– Presence

• Equality (right and left)

• Asymmetric
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Decreased on one side

– Absent
Breathing Assessment (5 of 6)
• Listen (auscultate) for breath sounds (cont’d)

– Abnormal sounds

• Wheezing

• Rales

• Rhonchi

• Crepitus (bony or subcutaneous emphysema)


Breathing Assessment (6 of 6)
• Feel (palpate) the chest for:

– Bony crepitus

– Subcutaneous emphysema

– Abnormal movement of the chest wall

– Bony tenderness
Common Injuries That Affect
Breathing
• Pneumothorax
– Simple
– Tension
– Open
• Hemothorax
• Rib fractures
– Simple
– Flail chest
Introduction
• Chest trauma is often sudden and dramatic
• Accounts for 25% of all trauma deaths
• 2/3 of deaths occur after reaching hospital
• Serious pathological consequnces:
• -hypoxia, hypovolaemia, myocardia failure
Hemothorax
• life-threatening injury number one
• Blunt or penetrating mechanism
• Bleeding into the pleural cavity
• May be associated with a pneumothorax
• Air or blood in the pleural space
compromises lung capacity
• May require surgical intervention
Etiology
• most often injuries of the chest of the bleeding in the chest wall and
blood vessels, lungs, heart and major blood vessels or damage to
the diaphragm.

• iatrogenic hemothorax: most common reasons for central venous


cannulation,drainage, pleurabiopsy, transthoracic pulmonarybiopsy,

• spontaneous hemothorax: rare disease


Trauma
Pathogenesis
thoraks

Lung laseration or laseration a. Chest pain


Intercostalis or a. Mamari interna

Lung development disorder


Blood aaccumulate in pleural Press the lung
cavity

Ventilation disorder
Progresif

Loss
bleeding O2 CO2
CO Dispnea
HR
RR (takipnea)
Blood
Preasure
Shock
Perifer blood flow
<<
Hemothorax Physical Findings

Anxiety/Restlessness
Tachypnea
Signs of Shock
Frothy, Bloody Sputum
Diminished Breath Sounds on
Affected Side
Tachycardia
Classification
A. Mild hematothorax

• Visible shadow less than 15% on r-say

• dullness to percussion until ribs 9

B. Moderet hematothorax

• Visible shadow less than 15-35% on x-ray

• Dullness to percussion until ribs VI

C. Severe hematothorax

• Visible shadow less than >35% on x-ray

• Dullness to percussion until ribs IV


Diagnosis
• anamnesis
• physical examination
• often in connection with pneumothorax accident mechanism,
subcutaneous emphysema can be detected
• X-ray examination shows the effusion, possible pneumothorax,
mediastinal throughput rate, rib fractures, etc.
• puncture
Diagnosis
• Complementary examinations :
• Chest x-ray CT-Scan
Therapy
• bed rest, routing: less than 500 ml in case of hemothorax; lower-grade fever
may accompany absorption; Duration: 1-2 weeks
• puncture: partly diagnostic and partly for therapeutic purposes; First get the
medical care have a role (diagnosis, relief)
• drainage: if more than 1000 ml hemothorax; Advantages: (1) improved
evacuation, (2) constant control bleeding, (3) faster than expected, fewer
complications
• VATS exploration: a causative diagnosis and the severity of the bleeding to
clarify
• thoracotomy is indicated when (1) vascular, lung, heart, diaphragm injury
there is a reasonable suspicion; (2) from the drain strong non damped
bleeding (more than 100 ml / h).
Treatment
- ABC’s with c-spine control as indicated
I - Secure Airway assist ventilation if necessary
- General Shock Care due to Blood loss
- Decompression/chest tube always by chest catchment in 5 ICS
on middle or posterior axillary line
- A massive hemothorax is defined as >1500 mL of blood for 2-4
hours, an indication for operative intervention, Indication of
emergency toracotomy.
25
Complication
• - Pneumothorax
• - Syok
• - Septisemia
• - Death
Chest trauma: summary
• Common
• Serious
• Primary goal is to provide oxygen to vital organs
• Remember
Airway
Breathing
Circulation
• Be alert to change in clinical condition

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