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    OlehDr. Exsa HadibrataBagian Anatomi

    FK Universitas Lampung

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    Gambar Fraktur costae :

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    Flail Chest

    Multiple rib fractures may allow a sizablesegment of the anterior and/or lateralthoracic wall to move freely.

    The loose segment of the wall movesparadoxically (inward on inspiration andoutward on expiration).

    Flail chest (stove-in chest) is an extremelypainful injury and impairs ventilation,thereby affecting oxygenation of the blood.

    During treatment, the loose segment isoften fixed by hooks and/or wires so that itcannot move.

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    Gambar Flail Chest

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    Dyspnea: Difficult Breathing

    When people with respiratory problems(e.g., asthma) or with heart failure struggle

    to breathe, they use their accessoryrespiratory muscles to assist the expansionof their thoracic cavity.

    They lean on their knees or on the arms of

    a chair to fix their pectoral girdle so thesemuscles are able to act on their ribattachments and expand the thorax.

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    Posisi tubuh saat asma

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    Pneumothorax, Hydrothorax, andHemothorax

    Entry of air into the pleural cavity (pneumothorax),resulting from a penetrating wound of the parietal pleurafrom a bullet, for example, or from rupture of a pulmonarylesion into the pleural cavity (bronchopulmonary fistula),results in collapse of the lung

    Fractured ribs may also tear the visceral pleura and lung,thus producing pneumothorax. The accumulation of a significant amount of fluid in the

    pleural cavity (hydrothorax) may result from pleuraleffusion (escape of fluid into the pleural cavity).

    With a chest wound, blood may also enter the pleural cavity(hemothorax)

    If both air and fluid (hemopneumothorax, if the fluid isblood) accumulate in the pleural cavity, an airfluid levelor interface (sharp line, horizontal regardless of thepatient's position, indicating the upper surface of the fluid)will be seen on a radiograph.

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    Gambar hidrothorax

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    Thoracosintesis Sometimes it is necessary to insert a hypodermic needle

    through an intercostal space into the pleural cavity(thoracentesis) to obtain a sample of fluid or to removeblood or pus

    To avoid damage to the intercostal nerve and vessels, the

    needle is inserted superior to the rib, high enough to avoidthe collateral branches. The needle passes through the intercostal muscles and

    costal parietal pleura into the pleural cavity. When thepatient is in the upright position, intrapleural fluidaccumulates in the costodiaphragmatic recess.

    Inserting the needle into the 9th intercostal space in the

    midaxillary line during expirationwill avoid the inferiorborder of the lung. The needle should be angled upward, toavoid penetrating the deep side of the recess (a thin layerof diaphragmatic parietal pleura and diaphragm overlyingthe liver).

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    Pulmonary Emboli Obstruction of a pulmonary artery by a blood clot (embolus)

    is a common cause of morbidity (sickness) and mortality(death).

    An embolus in a pulmonary artery forms when a blood clot,fat globule, or air bubble travels in the blood to the lungs

    from a leg vein, for example, after a compound fracture. The embolus passes through the right side of the heart to alung through a pulmonary artery. It may block a pulmonaryarterypulmonary embolism (PE)or one of itsbranches. The pulmonary arteries carry all of the blood thathas been returned to the right heart via the vena cavalsystem.

    Consequently, the immediate result of PE is partial orcomplete obstruction of blood flow to the lung. Theblockage results in a lung or a sector of lung that isventilated with air but not perfused with blood.

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    When a large embolus occludes a pulmonary artery, thepatient suffers acute respiratory distress because of a

    major decrease in the oxygenation of blood, owing toblockage of blood flow through the lung.

    Conversely, the right side of the heart may becomeacutely dilated because the volume of blood arrivingfrom the systemic circuit cannot be pushed through the

    pulmonary circuit (acute cor pulmonale). In either case, death may occur in a few minutes. Amedium-size embolus may block an artery supplying abronchopulmonary segment, producing a pulmonaryinfarct, an area of necrotic (dead) lung tissue.

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    Gambar Emboli Paru

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    Asma Bronkial

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    Corpus alienum

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    Anatomi Klinis Dasar. KL Moore

    Atlas of Human Anatomy. Netter

    Van De Graff of Human Anatomy. McGraw Hill