“DEADLY DOZEN”

pada Trauma Thoraks

Disusun Oleh :
Rafri Dinda Bermudi Mulia
Nadiya Nurhasanah Tiara Putri
Giovanno Oroh Vicky Hermawan

Pembimbing :
dr. Artono Isharanto, Sp.B, Sp BTKV
 Definisi trauma thorax

• Akibat trauma thorax

 LETHAL SIX HIDDEN SIX

• Airway Obstruction • Ruptur Aorta

• Tension • Ruptur Trakea
Pneumothorax • Ruptur Esofagus
• Cardiac Tamponade • Kontusio Pulmonum
• Open Pneumothorax
• Massive Hemothorax
• Ruptur Diagfragma DEADLY
• Kontusio Miokardial
• Flail Chest DOZEN

PRIMARY SURVEY SECONDARY SURVEY

ANATOMI DINDING TORAKS
 Six Lethal Threatening Injuries
DEADLY
DOZEN Six Hidden Threatening Injuries
Six Lethal Threatening Injuries

- Airway Obstruction
- Tension Pneumothorax
- Cardiac Tamponade
- Open Pneumothorax
- Massive Hemothorax
- Flail Chest
 AIRWAY OBSTRUCTION
Tanda
• Obstruksi parsial: stridor, gargling,
snoring, peningkatan usaha nafas
• Obstruksi total: gelisah, silent chest,
sianosis, anemis

Tatalaksana
• Secure : triple airway maneuver, suction,
finger swab
• Protect : OPA, NPA, ETT
• Provide : cricothyroidotomy, tracheostomy
 TENSION PNEUMOTHORAX
Tanda
• Unsymmetrical breathing (Inspeksi &
Palpasi)
• Peningkatan JVP (Inspeksi)
• Retraksi dada (Inspeksi)
• Deviasi trakea (Inspeksi)
• Suara nafas menurun (Auskultasi)
• Hipersonor (Perkusi)
Tatalaksana
• Needle thoracocentesis
• Chest Tube
 CARDIAC TAMPONADE

Tanda
• Beck’s triad (3D):
1. Distended jugular vein
2. Distant heart sound
3. Decreased Arterial Pressure
• Pulsus Paradoksus
• Kussmaul’s Sign

Tatalaksana
• Pericardiocentesis
• Pericardiotomy
 OPEN PNEUMOTHORAX
Tanda
• Sucking chest wound & gas bubble
• Unsymmetrical breathing (Inspeksi & Palpasi)
• Peningkatan JVP (Inspeksi)
• Retraksi dada (Inspeksi)
• Deviasi trakea (Inspeksi)
• Suara nafas menurun (Auskultasi)
• Hipersonor (Perkusi)

Tatalaksana
• Occlusive dressing (3 sisi)
• Chest tube
• Debridement & surgical exploration
 MASSIVE HEMOTHORAX
Tanda
• Syok hemoragik
• Jejas pada dada
• Peningkatan usaha nafas
• Sianosis
• Deviasi trakea
• Unsymmetrical breathing (Inspeksi & Palpasi)
• Suara nafas menurun (Auskultasi)
• Dullness (Perkusi)
Tatalaksana
• Fluid resuscitation
• Chest tube
• Thoracotomy
 FLAIL CHEST
Tanda
• Paradoxical chest movement
• Deformitas
• Sesak
• Nyeri -> Hipoventilasi
• Krepitasi (Palpasi)

Tatalaksana
• Pain control (analgetik, sedasi, blok)
• Intubation (jika diperlukan)
• Mechanical ventilation (jika diperlukan)
• Internal Fixation
Six Hidden Threatening Injuries

- Ruptur Aorta
- Ruptur Trakea
- Ruptur Esofagus
- Kontusio Pulmonum
- Ruptur Diagfragma
- Kontusio Miokardial
 RUPTUR AORTA
Sign
• Nadi ekstremitas tidak sama
• Hematoma supraklavikular
• Hipotensi
Chest x-ray:
• Widening mediastinum

Tatalaksana
• Tatalaksana awal primary survey
• Rujuk
• Pembedahan (laparotomy,
thoracotomy)
 RUPTUR TRAKEA
Sign
• Massive air leak
• Hemoptysis
• Subcutaneous Emphysema
Chest X-Ray
• Pneumothorax
• Falling lung sign of Kumpe
• Definitive diagnose is made with Bronchoscopy
Management
• Endotracheal intubation on the unaffected side
• Operative : Thoracotomy
 TRAUMA ESOFAGUS
Sign
• Mackler's triad
- Nyeri Dada
- Muntah
- EmphysemaSubkutis
Chest x-ray :
Widening mediastinum

Tatalaksana
• Tatalaksana awal primary survey
• Rujuk
• Pembedahan (torakotomi eksploratif)
 KONTUSIO PULMONUM

Sign
• Hipoxemia
• Hemoptysis
• Severe can cause ARDS
Radiology
• CXR : Typically delayed and non-segmental
• CT scan with contrast
Management
• Mild contusion : - oxygen administration
- aggressive pulmonary toilet
- adequate analgetic
• Severe contusion : mechanical ventilation
 RUPTUR DIAFRAGMA

Sign
• Bising usus pada regio toraks
• Organ abdomen pada rongga dada
Chest x-ray :
Gelembung udara pada hemithorax

Tatalaksana
• Tatalaksana awal primary survey
• Rujuk
• Pembedahan (laparotomy, thoracotomy)
 KONTUSIO MIOKARD
Sign
• Bruising of the cardiac muscle
• Sharp, retrosternal pain
• Abnormality in ECG
• Crackles or rales in auscultation
Radiology
• ECG
• Echocardiography
segmental wall abnormalities or valvular dysfunction
Managemet
• Establish airway
• High concentration of Oxygen
• Cardiac monitoring
• Analgetic