2_b_gangguan pernafasan.ppt

8/12/2019 2_b_Gangguan Pernafasan.ppt

1/20

1

Gangguan

Pernafasan

Bagian Anestesiologi dan ReanimasiFK Unsyiah RSUZA

Banda Aceh


2/20

2

Breathing Evaluation

Look - chest movement, flaring nostrils,intercostal retraction

Listen - breath sound, abnormal sounds

Feel - air movement through mouth / nose

Palpation - chest movement, symmetrical?

Percussion - Damped?Hypersonor ?Symmetrical?

Auscultation (stethoscope) - Breath soundpresents? Symmetrical?

Resusitasi


3/20

3

Signs of respiratory distress

Rapid shallow breathing

Flaring nostrils

Intercostal and neck

retraction

Rapid pulse

Hypotension

Distended neck veins

Cyanosis(late sign)


4/20

4

B- breathing

1. Breathing? Normal breathing or

distressed?

2. Open chest wound? Sucking wound?

3. Tension pneumothorax?

4. Rib fractures? Multiple ? flail chest

5. Hemothorax?

6. Subcutaneous emphysema?


5/20

5

Breathing? Normal breathing

or distressed?

No breath give

rescue breathing + O2

Gasping breath

give rescue breathing + O2

Rapid breathing > 25, flaring

nostrils, intercostal retraction give O2+ prepare rescue

breathing


6/20

6

Open chest wound?

Sucking wound?

Penetrating chest wound

Sucking chest wound

Close the wound


7/20

7

Open chest woundair enters pleural cavity


8/20

8

Air enters pleural cavity

- from outside(stab wound)

- from insided(torn bronchi)


9/20

9

A piece of plastic sheet

fix with adhesive tape on

3 sidesone way valve

to prevent pressure build-up

inside pleural cavity whileclosing the wound

previous method:

cover with sterile gauze

impregnated with vaselin

(risk of pressure build-up)

How to Cover Penetrating Chest Wound


10/20

10

Tension Pneumothorax

Diagnosis by clinical signs only

Affected side will show

Palpation less chest expansion

Palpation of trachea shifts away to normalside

Percussion hypersonor (empty sound)

Auscultation reduced breath sound

Do needle thoracostomy,

do not wait for X-ray confirmation


11/20

11

Palpate The Trachea at Sternal Notch

Look more

carefully for

pneumothorax inthe presence of

Rib fractures

Subcutaneousemphysema


12/20

12

Needle Thoracostomy to Confirm Pneumothorax

(Needle and Filled Syringe System)

Bubble (+)= pneumothorax

Dont pull out the

needle until thoracic

drain is inserted

Bubble (-) and the

water was sucked

slowly inside

= no pnumothoraxPull needle out before

the syringe emptied

to avoid inducing

pneumothorax

lenght5 cm

water


13/20

14

Rib fractures? Flail Chest ?4.

Inspiration Expiration


14/20

15

1

2

Hemothorax?5.


15/20

16

Subcutaneous EmphysemaFeels like grasping thin plastic sheet

Most caused by pneumothorax


16/20

17

Artificial ventilation

12-20 x / minute, until chest rises

start ventilation to abnormal breathing, do not

delay until apnea occurs additional oxygen (if available)

if air enters the stomach, do not deflate by

pressing the epigastrium (risk of aspiration).Insert a nasogastric tube instead


17/20

18

Artificial ventilation was provided along with in-line

immobilisation (hold the head and neck)

to prevent the neck from moving excessively


18/20

19

Artificial ventilation via tracheal tube:1. More effective oxygenation and removal of CO2

2. Prevent pulmonary aspiration

3. No interruption of cardiac compression during CPR


19/20

20

Any Question.


20/20

21

T NKS

2_b_gangguan pernafasan.ppt

Documents