tension pneumothoraks dan tatalaksananya

7/27/2019 tension pneumothoraks dan tatalaksananya

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Dr. Andreas AL.


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* The endotracheal tube is too

far dawn

The ideal position is for the

tip of the tube to be at the le-

vel of the clavicles

A lucent area at the anterior

costophrenic recess on the

right side with no lung mar-

kings ---- deep sulcus sign

----- indicative right pneumo

thorax

* The right hemidiapragm is

depressed and the mediasti-

num shifted away indicating

A tension pneumothorax


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If you see a significant tensionpneumothorax on radiograph,

YOU HAVE MISSED THE CLINICAL DIAGNOSIS


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Tension Pneumothorax

Associated Injuries

A penetrating injury to the chest

Blunt trauma

Penetration by a rib fracture

Many other mechanisms of

injury


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Tension Pneumothorax Morbidity/Mortality

Profound hypoventilation can result.

Death is related to delayed management.

An immediate, life-threatening chest injury.


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Pathophysiology(1 of 2)

Occurs when air enters the pleural space from a lung

injury or through the chest wall without a means of exit.

Results in death if it is not immediately recognized and

treated

When air is allowed to leak into the pleural space duringinspiration and becomes trapped during exhalation, an

increase in the pleural pressure results.


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TENSION PNEUMOTHORAX


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Tension Pneumothorax Pathophysiology (2 of 2)

Increased pleural pressure produces mediastinal

shift.

Mediastinal shift results in:

Compression of the uninjured lung Kinking of the superior and inferior vena cava,

decreasing venous return to the heart, and

subsequently decreasing cardiac output


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Assessment Findings (1 of 3)

Extreme anxiety

Cyanosis

Increasing dyspnea

Difficult ventilations while being assisted

Tracheal deviation (a late sign)

Hypotension

Identification is the most difficult aspect

of field care in a tension pneumothorax.


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Tachycardia

Diminished or absent breath sounds on

the injured side

Tachypnea

Respiratory distress


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Bulging of the intercostal muscles

Subcutaneous emphysema

Jugular venous distention

Unequal expansion of the chest

Hyperresonnace to percussion


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Physical Findings


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Tension Pneumothorax Management (1 of 5)

Emergency care is directed at reducing thepressure in the pleural space.

Airway and ventilation: High-concentration oxygen

Positive pressure ventilation if necessary

The positive pressure ventilation makes a tensionpneumothorax worse (keep this in mind any timeyou see someone with sudden cardiopulmonarydeterioration after intubation)

Circulationrelieve the tensionpneumothorax to improve cardiac output.


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Nonpharmacological

Needle thoracostomy

Tube thoracostomyin-hospital management


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Management

TENSION PNEUMOTHORAX

NEEDLE

TORAKOSINTESIS

Tension

PneumothoraxSimple

pneumothorax


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Tension Pneumothorax Management(3 of 5)

Needle thoracostomy

Insert the needle just above the third rib to avoid the nerve,

artery, and vein that lie just beneath each rib.


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Tension pneumothorax associated with

penetrating trauma

May occur when an open pneumothorax has beensealed with an occlusive dressing.

Pressure may be relieved by momentarily removing

the dressing (air escapes with an audible release of

air).

After the pressure is released, the wound

should be resealed.


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Management (5 of 5) Tension pneumothorax associated with closed

trauma If the patient demonstrates significant dyspnea and

distinct signs and symptoms of tension

pneumothorax: Provide thoracic decompression with either a large-bore

needle or commercially available thoracic decompression kit.

Insert a 2-inch 14- or 16-gauge hollow needle or catheter intothe affected pleural space.

Usually the second intercostal space in the midclavicular line

Insert the needle just above the third rib to avoid the nerve,

artery, and vein that lie just beneath each rib.


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WHAT IS THE SIGNIFICANCE OF

SUBCUTANEOUS EMPHYSEMA AFTER

CHEST TUBE PLACEMENT FOR A

PNEUMOTHORAX ? WHAT IS THETREATMENT? IS IT DANGEROUS ?

Sharing experience in ward.


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tension pneumothoraks dan tatalaksananya