All About Torax Trauma
1. Question:
What is a trauma?
Answer:
Conditions caused by a wound or injury.
2. Question:
What’s thorax trauma?
Answer:
Thorax trauma is an injury or injuries related to the thorax or chest cavity can cause damage to the thorax or chest wall or the contents of the cavum thorax (chest cavity) caused by sharp or blunt object and can cause pain in your chest condition.
3. Question:
Organ whatever thorax pain due to trauma?
Answer:
Traumatic injury to the thorax or chest can cause damage to the chest wall, lung, heart, large blood vessels and surrounding organs including the viscera (organs in the great variety in the chest cavity).
4. Question:
In the thorax or chest trauma, are classified into how many?
Answer:
Broadly speaking the thorax or chest trauma are classified into two, namely:
a) blunt trauma, which is mostly caused by traffic accidents.
b) penetrating the thorax or chest trauma, because trauma can be caused by a sharp (sharps puncture), gunshot trauma (gunshot), and a penetrating blunt chest trauma.
5. Question:
What is the process of changes that occur due to the trauma of the thorax or patofisiologinya?
Answer:
As a result of the thorax or chest trauma that occurred, causing the failed ventilation (air turnover), failure of gas exchange at the alveolar level (a small organ-like pockets in the lungs), circulatory failure due to changes in hemodynamic (blood circulation). This third factor may cause hypoxia (lack of supply of O 2) in hypoxia sustained cellular network. Hypoxia at the tissue level could cause stimulation of the cytokines that can stimulate the occurrence of Adult Respiratory Distress Syndrome (ARDS), Systemic Inflamation Response Syndrome (SIRS) and sepsis.
6. Question:
What’s the worst effects of the trauma of the thorax and the cause?
Answer:
Impact trauma of the thorax is worst than death, is caused by shock.
7. Question:
How do I know the client with the trauma of experiencing a shock thorax?
Answer:
Ø Akral cold and wet:
o Cold à contraction due to peripheral vascular perfusion to meet the vital organs.
o Wet sympathetic mechanism à à à stimulate adrenaline increased sweating.
Ø rapid and weak pulse
o Fast due to meet the perfusion.
o Weak due hipovolemi.
o Hypoxia (lack of supply of O 2).
o Hiperkabnia (excess CO 2 in the blood).
o Metabolic Acidosis.
8. Question:
In examining the blood pressure of patients with shock, why not under tension?
Answer:
Why is not based on the tension, because adnya homestatis mechanism so that adrenaline increased vasoconstriction à à tension increases. So that the tension can be normal shock, whereas hypovolemic patients (lack of fluid volume in the body).
9. Question:
General symptoms such as what is often shown that it is a result of the trauma of the thorax?
Answer:
Symptoms are often seen on the thorax trauma was the chest pain and shortness of breath or pain when breathing.
10. Question:
What action needs to be done for health workers in the emergency room when dealing with people with thorax trauma?
Answer:
Meeting clients look sick, congested or sianotik with signs of trauma or lesion on his chest piston. More than 90%, thorax trauma does not require any form of Thoracotomy surgery (surgery on the breasts), but the act of saving early and elementary action needs to be done and acknowledged by every officer who receives or watch in the emergency room. This early rescue action is very important for the prognosis of patients with trauma of the thorax.
11. Question:
What is the purpose of elementary actions in people traumatized thorax?
Answer:
The elementary actions are:
a) Releasing and ensure smooth airway.
b) Install the infusion and fluid resuscitation.
c) Reduce and eliminate pain.
d) Monitor the patient’s consciousness.
e) Perform chest x-ray production if necessary in two directions.
12. Question:
In the client with thorax trauma requiring surgery how serious or immediate?
Answer:
In the client with obstruction (no obstruction) in the airway, hemotoraks massif (blood clotting / bleeding), tamponade pericardium / heart (blockage) which caused a lot of penetrating cardiac stab wounds, tension pneumothorax, flail chest, open pneumothorax, leakage of bronchial and trakeobronkial .
13th. Question:
In terms of questions and answers between the health worker with the client, what needs attention?
Answer:
Ø It should be asked about the mechanism of trauma, whether by a fall from a height or a fall and banged his chest on a hard object, traffic accidents, or by other reasons.
Ø Pain is the most common complaints are usually settled in one spot and will be added when breathing. At the time of inspiration the thoracic cavity expands and the situation will move costa broken fragments, so that will cause friction between the end of the fragment with the surrounding soft tissue and this situation will lead to painful stimuli.
Costa fragment Ø If this will cause damage to the vascular can cause hematotoraks, while if the fragment costa injure the lung parenchyma will cause a pneumothorax.
Ø Patients with difficulty breathing or even when coughing out blood, it indicates the existence of complications in the form of injury to the lung.
Ø History formerly diseases such as bronchitis, neoplasm, asthma, haemoptisis or after exercise will help direct the diagnosis of fracture of costa.
Ø The child may or heart lung injury, although no fractures were found costa. This situation caused costanya still very flexible, so that the energy direct trauma on the heart or lungs.
14. Question:
The principle of any physical examination used in the trauma of the thorax?
Answer:
Inspection Ø à lesion, symmetrical, breathing paradox.
Palpation Ø à NT (+), right and left differ fremitus, krepitasi.
Percussion Ø à resonant (normal), dim (liquid), hipersonor (air).
Auscultation Ø à vesicular, an additional voice.
15. Question:
How to move from assessment and management of clients with trauma to the thorax?
Answer:
Ø Management of patients consists of:
a) Primary survey, which is done on a life-threatening trauma, help begins with airway, breathing, and circulation.
b) Resuscitation vital functions.
c) Secondary survey detail.
d) a definitive treatment.
Ø Because hypoxia is an extremely serious problem in the thorax trauma, early intervention and prevention needs to be done to correct it.
Ø The nature of life-threatening trauma is directly carried out as quickly and as simply as possible therapies.
Ø Most of the thorax trauma cases were treated with life-threatening airway control or perform the installation of hose thorax or thorax with a needle decompression.
Ø Secondary survey history of trauma and require high vigilance against the traumas that are special.
16. Question:
Hemotoraks or bleeding in the chest is heavy (> 800 cc), lung laceration which failed with conservative surgery, pericardium tamponade, leak-bronchial trakheo who failed with conservative measures (drainage), a sign of?
Answer:
It’s all a sign of the trauma of the thorax to be done Thoracotomy.
17. Question:
Broadly speaking, whatever the chest area could be affected by the trauma of the thorax?
Answer:
In the area of the chest wall and chest cavity.
18. Question:
Any diagnosis that can be drawn from the client with thorax trauma?
Answer:
Various kinds of diagnosis that can be taken related to the thorax trauma clients are:
Ø In the chest wall:
a) Broken ribs, singular and plural, is the most common type.
b) Flailchest, as a result of multiple rib fractures on one segmental chest wall.
Ø In the chest cavity:
a) Pneumotorak, caused by a tear or opening of the pleura and chest wall. Pneumotorak which can be either open or closed and tightened (“tension pneumotorak”). About 75% of trauma accompanied hemotorak pneumotorak puncture.
b) Hemotoraks, the presence of blood in the pleural cavity. Hemotorak divided into mild if the total up to 300 ml of blood only. Hemotorak is when the amount of up to 800 ml of blood and blood hemotorak weight when the number exceeds 800 ml.
c) Damage to the lungs, 75% caused by the piston explosion trauma (blast injury). Bleeding which occurs mostly trapped in the lung parenchyma.
d) Damage to the trachea, bronchus and trakeobronkoalveolar system. Airway leak occurred mainly through the pleura, or under the skin under the breast causing emphysema subcutis. Mostly caused by blunt trauma piston in the sternum area.
e) Damage to heart tissue and pericardium, the most common cause is trauma piston sharply in parasternal region II-V which causes penetration to the heart. Other causes are cardiac terjepitnya by the crush of the sternum on reciprocating blunt trauma.
f) Damage to the esophagus, are relatively rare. Cause pain especially when swallowing and in a few hours febrile arise. Vomiting blood / hematemesis, hoarseness, dysphagia or respiratory distress.
g) Damage torasikus ductus.
h) Damage to the diaphragm, generally caused by trauma to the abdominal area, or penetrating wounds sharply towards torakoabdominal. Will lead to herniation of abdominal organs. Rarely right more than left.
19. Question:
From a variety of diagnoses at the top, like a sign of what is commonly arise from each of those diagnosed?
Answer:
Ø In the chest wall:
a) Broken ribs, singular and plural. The main sign is tertinggalnya breath movement in the fracture area, accompanied by pain or shortness of breath and time.
b) Flailchest, characterized by a paradoxical breathing movements. Visible part of the inspiration time enter into and going out of expiratory time. This causes the shock motion mediastinal cavity (flailing), which may cause the insertion inferior vena cava (inclusion of blood to the heart through veins bottom) pressed and squeezed.
Ø In the chest cavity:
a) Pneumotorak, characterized by shortness of breath.
b) Hemotoraks, indicated by the decrease in volume of body fluids.
c) Damage to the lungs, characterized by decreased ability to breathe.
d) Damage to the trachea, bronchus and trakeobronkoalveolar system. Marked by difficulty breathing, enlargement of the neck and the existence of crepitasi on the chest wall.
e) Damage to the heart and pericardium tissue. Marked by the decline in the volume of body fluids, there is the primary obstruction, and decreasing the pulse time of inspiration.
f) Damage to the esophagus. Marked with patients who appear unhealthy and abnormal sounds like chewing on the heart when checked with a stethoscope.
g) Damage torasikus ductus. Marked by shortness of breath due to lung collapse.
h) Damage to the diaphragm. Does not give the typical signs, shortness of breath is often accompanied by visible and signs or symptoms of pneumothorax hemotoraks.
20. Question:
Please list the steps in the determination of diagnosis with thorax trauma?
Answer:
Diagnostic steps:
Ø In general, the clinical diagnosis is established from the type of damage incurred and the making of chest x-ray images. Where possible, the x-ray images should be made in two directions (PA and lateral directions).
Ø The lesion in the chest area will help the possibility of reciprocating trauma. When there are multiple trauma then it is advisable to always make chest x-ray images.
Ø Signs and symptoms such as the presence of accompanying shock (hypotension, rapid pulse and cold sweat) and the other organs of the chest trauma is an important diagnostic point. Installation of NGT as preparation for gastric emptying to prevent aspiration of contents labung into the lungs, can be used as diagnostic measures and damage the esophagus and diaphragm.
Basically Ø piston diagnostic trauma should be enforced as soon as possible, without using the old way of diagnostic (Ct-scan, angiography).
Ø Examination of blood gases can be helpful when diagnostic facilities exist.
21. Question:
In the trauma of the thorax, whatever complications may arise?
Answer:
Ø The instability associated with chest wall:
a) the pain is prolonged, although the wound was healed. Perhaps because the callus or scar tissue that suppress the intercostal nerve.
b) Osteomylitis.
c) Retention of sputum, as coughing and can not cause pneumoni adequat.
Ø The related injury and bruised lung:
a) pulmonary infiltrates and pleural effusion.
b) Empyema, which happens slowly. WSD and require antibiotics.
c) Pneumoni, is a dangerous complication.
d) bronkopleural Fistel, characterized by symptoms of lung collapse which did not improve.
e) Chylotoraks slow.
Ø Complications other than lung and pleura:
a) mediastinitis, an often fatal complication.
b) Fistel esophagus into the mediastinum and can lead to mediastinitis or pleural and menimbulkana empyema or pleural effusion.
c) slow diaphragmatic hernia.
d) Kalainan heart, especially at sharp trauma and penetrating wounds of the heart.
22. Question:
What can be done or given by health workers associated with complications that can arise from trauma of the thorax?
Answer:
Ø The instability associated with chest wall:
d) prolonged pain, even though the wound had healed. Perhaps because the callus or scar tissue that suppress the intercostal nerve. Conservative therapy with anlgesik or scar tissue softener.
e) Osteomylitis. Done squesterisasi and fixation.
f) Retention of sputum, as coughing and can not cause pneumoni adequat. Necessary provision mukolitik.
Ø The related injury and bruised lung:
f) pulmonary infiltrates and pleural effusion. Requires installation of WSD for a long time.
g) Empyema, which happens slowly. WSD and require antibiotics.
h) Pneumoni, is a dangerous complication. Need to be given the optimal treatment, if the distress pernafassan sustainable it needs the installation of a respirator.
i) bronkopleural Fistel, characterized by symptoms of lung collapse which did not improve. Require surgical follow-up and closure of a exploratory Thoracotomy fistelnya.
Ø Complications other than lung and pleura:
a) mediastinitis, an often fatal complication. If there pernanahan the mediastinal drainage should be performed.
b) Fistel esophagus into the mediastinum and can lead to mediastinitis or empyema, or pleural effusion and menimbulkana pleua. Surgical intervention is required to cover fistel.
c) slow diaphragmatic hernia, requiring surgical correction.
d) Kalainan heart, especially at sharp trauma and penetrating wounds of the heart. Require surgery and open heart surgery.
23. Question:
Please list the management of different conditions associated with the trauma of the thorax?
Answer:
Treatment in emergencies and during therapy.
24th. Question:
Explain the general principles of management that is used in dealing with thorax trauma?
Answer:
The treatment follows the principle of management of trauma patients in general (primary survey – secondary survey). On primary survey we must be able to recognize a state or thoracic trauma disorders caused by a dangerous and deadly that must be managed immediately, such as:
o Airway obstruction.
o massive intra-thoracic haemorrhage (massive hemotoraks).
o Tension pneumothorax.
o Ruptured aorta and rupture trakheobronhial.
o Ruptured diaphragm with herniation of viscera.
o tamponade.
o Heavy Flail chest with pulmonary contusions.
o esophageal perforation.
Diagnostic checks can only be done when the patient is stable and is not allowed to move patients from the emergency room or resuscitation. Handling is not to diagnose patients but especially to find the problems that threaten the lives and perform lifesaving measures.
25. Question:
Explain and how the management of clients with the trauma of the thorax based on condition?
Answer:
Ø Emergency:
a) diagnose the complete and rapid. Anamnesis, including an introduction that might see the incident, which asked:
o Time events.
o Place of incident.
o Type of weapon.
o The direction in and out of injury.
o How is the patient during transport.
b) The examination must be complete and quick, patient clothing should be removed, if necessary, all of which include:
o Inspection:
a. If the patient may sit, if not sleep. Determine entry and exit wounds.
b. Move around and position at the end of inspiration.
c. End of expiration.
o Palpation:
a. Palpable no / not krepitasi.
b. Tender anteroposterior and laterolateral.
c. Fremitus right and left and compared.
o Percussion:
a. The existence of resonant, timpanis, or hipersonor.
b. Aadanya boundary between the deaf and hard of hearing and resonant like a straight line or a slash.
o Auscultation:
a. Noisy breathing right and left and compared.
b. Noisy breathing weakened or not.
c. Noisy breathing is missing or not.
d. The border between the noisy breathing weaken or disappear with normal.
e. Noisy breathing abnormalities and specify if any.
c) Examination of blood pressure.
d) If you need to immediately put an IV.
e) examination of consciousness.
f) Examination of peripheral circulation.
g) If the state of emergency puncture.
h) If necessary intubation aid breathing.
i) If an emergency situation, if you need to massage the heart.
j) If necessary Thoracotomy internal cardiac massage.
k) If a state of stability may be requested radiological examination (thorax AP Photo, if at all possible).
Ø Therapy:
a) Chest tube / drainage air (pneumothorax).
b) WSD (hematotoraks).
c) puncture.
d) Thoracotomy.
e) The provision of oxygen.
REFERENCES
Carpenito, LJ 1997. Diagnosis of nursing. EGC: Jakarta.
Dorland, WA Newman. 2002. Medical Dictionary. EGC: Jakarta.
Faculty of medicine. 1995. Collection of lectures of surgery. Binarupa alphabet: Jakarta.
Schwartz, Seymour I. 2000. Abstract principles of surgery. Edition 6. EGC: Jakarta.
Smeltzer, Suzanne C. 2001. Medical-Surgical Nursing Brunner and suddarth. 8th Edition Volume 3. EGC: Jakarta.
Syamsuhidayat, R., Wim De Jong. 1995. Surgical textbook. EGC: Jakarta.
Related posts:
- Epidermoid Carcinoma 1. Explain about epidermoid carcinoma? Answer: a malignant lung tumor...
Related posts brought to you by Yet Another Related Posts Plugin.
Hello,this is Lynwood Conte,just found your web-site on google and i must say this blog is great.may I share some of the Post found in your site to my local mates?i am not sure and what you think?in any case,Thank you!