Tugas Thorax

CARA MENGHITUNG PNEUMOTHORAX

1. BTS Guidelines :
Dibagi kecil dan besar kecil < 2 cm dari antar batas paru dan dinding thorax. Besar jika>
2cm
2. % collins= 4.2+4.7 (Interpleural Distance)A+B+C .sum of interpleural distances in
centimeters at apex (A), midpoint of upper half of collapsed lung (B), and midpoint of lower
half of collapsed lung (C)
3. Light  100-100.(b/a)3
Ket : average diameter of the lung3 (A)/average diameter of hemithorax3 (B)
4. Rhea susah

Site Chest tube insertion

1. Midaxillaris anterior dibelakang pectoralis mayor

2. Posterior posisi
3. Aical pneumothorax  dipasang di intercostal space ke dua mid clacicular line

Kapan indikasi intubasi

1. RR > 40 x/menit
2. PO2< 60%

Kriteria ekstubasi

1. Vital capacity 10-15 ml/kgbb

2. Tekanan inspirasi diatas 20 cm H2o
3. paO2 > 80 mmhg
4. kardiovaskular dan metabolaikdalam batas normal
5. tidak ada efek sisa dari obat pelemas otot

Emergency cliffer ; fraktur lebih or sama dengan 6 costae

Blebs
Miller68 defined pulmonary blebs (Fig. 87-1) as well-circumscribed intrapleural airspaces
separated from the underlying parenchyma by a thin pleural covering. They result from
subpleural alveolar rupture, which occurs when the elastic fibers in the alveoli have been
stretched beyond the breaking point. The outer wall of a bleb is made up of visceral pleura;
the underlying lung is normal. Blebs are small and peripheral and most are located at the lung
apices. Not uncommonly, blebs will coalesce to form larger airspaces or even giant bullae. In
2007, Amjadi et al.,3 in examining the prevalence of blebs in 250 healthy adults who were
undergoing thoracoscopic sympathectomy for essential hyperhydrosis, found a 6%
prevalence of blebs. Individuals who had blebs versus those without blebs had a significantly
lower body mass index (BMI) and trended toward being more likely to smoke.
Figure 87-1. Pulmonary blebs. Operative photograph shows well-circumscribed subpleural
blebs at the apex of the lung.
Bullae
Bullae can be associated with any variety of emphysema. Their walls are made up of
destroyed lung; inside, they are crisscrossed by fibrous strands that are the remnants of
interlobular septa. Small bronchial openings are usually located at the base of a bulla. Reid94
distinguished three types of bullae: Type 1 projects from the pleural surface like a mushroom;
it has a narrow neck and an empty sac except for a few strands of tissue. It represents a small
amount of greatly overdistended lung. Type 2 has a broad neck, is produced by relatively less
overinflation of a shallow subpleural layer of lung, and its sac usually contains strands of
tissue, most frequently near its base. Type 3 has only moderate protrusion above the pleural
surface and represents the least overinflation of a much deeper region of the lung. In addition,
this bulla has no well-defined neck, and contains emphysematous lung evenly throughout.
Most surgeons prefer a more practical classification52 of bullous emphysema that is based on
the presence or absence of significant anatomic emphysema in the nonbullous