Tension Pneumothorax

Definisi
Bertambahnya udara dalam rongga pleura
secara progresif, biasanya karena laserasi
paru-paru yang memungkinkan udara untuk
masuk ke dalam rongga pleura tetapi tidak
dapat ditahan keluar atau tertahan di rongga
pleura.
Etiologi
Bisa terjadi secara primer (tanpa penyakit
paru-paru kronis) dan sekunder (dengan
penyakit paru kronis).
Trauma fisik ke thorax.
Komplikasi dari perawatan medis Ventilasi
tekanan positif yang memperburuk efek one-
way valve.

Patofisiologi
Figure 22-3. Closed (tension) pneumothorax produced by a chest
wall wound.
Figure 22-4. Pneumothorax produced by a rupture in the visceral pleura that
functions as a check valve.
Gejala Klinis
Hipotensi
Takikardi
Trachea deviasi ke arah
kontralateral
Ekspansi paru menurun
Perkusi hipersonor
Suara nafas vesikular
menurun
Tekanan vena jugularis
naik

Diagnosa
Diagnosis berdasarkan gejala klinis
Jangan di foto rontgen segera tatalaksana!
Clinical Data Obtained from
Laboratory Tests and Special
Procedures
Pulmonary Function Study:
Lung Volume and Capacity Findings
V
T
RV FRC TLC

N or

VC

IC ERV RV/TLC%
N

Arterial Blood Gases
Small Pneumothorax
Acute alveolar hyperventilation with
hypoxemia
pH PaCO
2
HCO
3
-
PaO
2

(Slightly)
Time and Progression of Disease
100
50
30
80
0
10
20
40
Alveolar Hyperventilation
60
70
90 Point at which PaO
2

declines enough to
stimulate peripheral
oxygen receptors
PaO
2
Disease Onset
P
a
O
2

o
r

P
a
C
O
2

Figure 4-2. PaO
2
and PaCO
2
trends during acute alveolar hyperventilation.

Arterial Blood Gases
Large Pneumothorax
Acute ventilatory failure with hypoxemia
pH PaCO
2
HCO
3
-
PaO
2

(Slightly)
Time and Progression of Disease
100
50
30
80
0
10
20
40
Alveolar Hyperventilation
60
70
90
Point at which PaO
2

declines enough to
stimulate peripheral
oxygen receptors
Acute Ventilatory Failure Disease Onset
Point at which disease becomes
severe and patient begins to
become fatigued
P
a
0
2

o
r

P
a
C
0
2

Figure 4-7. PaO
2
and PaCO
2
trends during acute ventilatory failure.
Oxygenation Indices
Q
S
/Q
T
DO
2
VO
2


C(a-v)O
2

Normal (severe)
O
2
ER SvO
2


Radiologic Findings

Chest radiograph
Increased translucency
Mediastinal shift to unaffected
side in tension pneumothorax
Depressed diaphragm
Lung collapse
Atelectasis
Hemodynamic Indices
(Large Pneumothorax)
CVP RAP PA

PCWP



CO SV SVI

CI

RVSWI LVSWI PVR

SVR

Figure 22-9. Left-sided pneumothorax (arrows). Note the shift of the heart and mediastinum to
the right away from the tension pneumothorax.
Figure 22-10. A, Development of a small tension pneumothorax in the lower part of the right lung (arrow). B, The same
pneumothorax 30 minutes later. Note the shift of the heart and mediastinum to the left away from the tension
pneumothorax. Also note the depression of the right hemidiaphragm (arrow).
A
B
General Management of
Pneumothorax
>20%gas should be evacuated
Negative pressure5 to 12 cm H
2
O
Should not exceed negative 12 cm H
2
O
General Management of
Pneumothorax
Respiratory care treatment protocols
Oxygen therapy protocol
Hyperinflation therapy protocol
Mechanical ventilation protocol
General Management of
Pneumothorax
PLEURODESIS
Chemical or medication injected into the chest
cavity
Talc
Tetracycline
Bleomycin sulfate
Produces inflammatory reaction between
lungs and inner chest cavity
Causes lung to stick to chest cavity