THORACIC TRAUMA Keperawatan Gawat Darurat 1
Ns. Siska Natalia,MSN-Palliative
Care
OBJECTIVES
Asuhan keperawatan pasien dengan kegawatan trauma
thorax
1.Pengertian trauma
2.Penyebab/Faktor resiko trauma thorax,
3.Patofisiologi
4.Tanda dan gejala trauma thorax
5.Penanganan Kegawatan trauma thorax
6.Askep Kegawatan trauma thorax
ANATOMY AND PHYSIOLOGY
Costae
Sternum
Trachea
Broncus
Lungs
Heart
Great vessels:
aorta
ASSESSMENT
I : INSPECTION
P : PALPATION
P : PERCUSSION
A : AUSCULTATION
LAB VALUES: Blood Gas Analysis, Full blood Count
RADIOLOGY : X-ray, CT SCAN, MRI
DEFINISI DAN ETIOLOGI
TRAUMA:
Trauma occurs when an external force of energy impacts
the body and causes structural or physiologic alterations,
or injuries.
ETIOLOGI:
External forces can be radiation, electrical, thermal,
chemical, or mechanical forms of energy
Blunt or Penetrating Injury
(Urden, Stacy, & Lough 2014)
CONTOH TRAUMA THORAX
Tension pneumothorax
Open Pneumothorax
Hemothorax
Tracheobronchial tree injury
Traumatic aortic disruption, Traumatic diaphragmatic
injury
Blunt esophageal rupture
Cardiac Tamponade
Flail Chest, Pulmonary contusion
PATOFISIOLOGI
Hypoxia, hypercarbia, and acidosis often result
from chest injuries.
Blood loss – hypovolemia – hypoxia - pulmonary
ventilation/perfusion mismatch - changes in the
intrathoracic pressure
This hypoperfusion leads to metabolic acidosis.
Changes in the intrathoracic pressure - inadequate
ventilation - Respiratory acidosis – Hypercarbia -
depressed level of consciousness
TENSION PNEUMOTHORAX:
SIGNS AND SYMPTOMS
• Pain – sharp, pleuritic pain
• Air hunger
• Respiratory distress
• Tachycardia
• Hypotension
• Tracheal deviation away from
the side of injury
• Unilateral absence of breath
sounds
• Neck vein distention- JVP
• Cyanosis (late manifestation)
PHYSICAL 1. Inspeksi: respiratory distress,
pengembangan dada asimetris
ASSESSMENT 2. Auskultasi: suara napas
bilateral, +/-
3. Palpasi: Deviasi trachea
Monitor:
Hypoxia (RR cepat/tachypnea)
Hypoxemia
Hypotension
Jika pasien tidak stabil
Pemeriksaan penunjang/Chest X-
Ray dapat ditunda
INTERVENTIONS
ABC
O2 Therapy : hindari
memberikan positive
pressure ventilation
Needle Decompressions
Chest tube/thorachostomy
PENETRATING INJURY:
OPEN PENUMOTHORAX/SUCKING CHEST WOUND
Large defects of
the chest wall that
remain open.
OPEN PNEUMOTHORAX: INTERVENTIONS
Oxygen
Occlusive Dressings
SURGERY
Sucking Chest Wound
video:
https://www.youtube.com/
watch?v=hBGtfeb80R8&fe
ature=youtu.be
FLAIL CHEST
MORE THAN TWO FRACTURES IN ONE SEGMENT.
Sign and Symptoms:
Tachipnea
Paradoxal Breathing
Hipoxia
Pain
MASSIVE HEMOTHORAX
Accumulation of blood
and fluid in a
hemithorax,
Compromise
respiratory efforts by
compressing the lung
and preventing
adequate ventilation
CARDIAC TAMPONADE
CARDIAC TAMPONADE
CARDIAC TAMPONADE
SIGN AND SYMPTOMS INTERVENTIONS
BECK TRIAD:
1. JVP meninggi
2. Hipotensi
3. Suara jantung
menjauh
INTERVENTIONS PRIORITY
Intubation , Ventilation,
Chest Tube/Thoracostomy
Fluid resuscitation, consider blood replacements
Position : semi fowler if no contraindications
Nursing considerations:
Correct placement?
Monitor? LOC, Sat O2, Vital signs + pain scale, Urine output
Evaluation?
NURSING PROBLEMS
A: Airway clearance
B: Ineffective Breathing Pattern
Impaired Gas Exchange – Blood gases
C: Cardiac Output decreased
D: Activity intolerance, impaired mobility
Pain, Family distress/anxiety, death and grieving
CASE STUDY
A 27-year-old male was the unrestrained driver in a high-
speed, frontal-impact collision. He was drunk and found a
bottle of whisky in the car seat. Vital signs are: blood
pressure 90/70; heart rate 110; and respiratory rate 36.
Initial assessment reveals a Glasgow Coma Scale (GCS)
score of 15 and a patent airway. Pain Score 9 out of 10.
The patient has distended neck veins and a deviated
trachea with absent breath sounds on the right.
A needle has been placed in the second intercostal space,
at the midclavicular line in the right hemithorax.
Build your concept maps in group, you may add some
additional data.
REFERENCES
American college of surgeon. (2012). Advanced Trauma Life
Support 9th ed. Ebook
Urden, L.D, Stacy, KM, & Lough, ME. (2014). Critical Care Nursing,
Diagnosis and Management. Philadelphia: Elsevier
