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    TENSION PNEUMOTHORAX

    Pediatric Res irolo D

    1

    Helmi Lubis, dr, SpAK

    Ridwan M. Daulay, dr, SpAK

    Wisman Dalimunthe, dr, Sp

    Rini S. Daulay, dr, M.Ked(Ped), S

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    Pneumothorax

    Accumulation of extra pulmonary air

    within the chest

    Uncommon durin childhood

    2

    Result from leakage of air from withi

    lung

    Air leaks:

    SpontaneousTraumatic

    Iatrogenic

    Catamenial

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    Spontaneous Pneumotho

    Primaryoccurs without trauma or

    underlying lung disease

    Secondarcom lication of underl

    3

    lung disorder but without trauma:Pneumonia

    Pulmonary abscess

    GangreneInfarct

    Asthma

    Foreign body in the lung

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    Traumatic Pneumothorax

    External chest / abdominal blunt /

    penetrating traumatear a bronchus or

    4

    pleural space

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    Iatrogenic Pneumothora

    Complicate of:

    Tracheostomy

    5

    Transbronchial byopsi

    Acupunture treatment

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    Catamenial Pneumothorax

    Unusual condition

    Associated with menses

    6

    air through diaphragmatic defect

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    Clinical Manifestations

    Pain

    Dyspnea

    Cyanosis

    Involved lung:

    7

    Decreased breath sounds

    Percussion: tympanitic

    Larynx, trachea and heartshifted

    toward unaffected side

    Gurgling sounds synchronous wit

    respirationopen fistula connectin

    with air containing tissues

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    Diagnosis

    Radiographic examination

    8

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    9

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    Evidence oftension:

    Shift of mediastinal structure away f

    the side of air leak

    10

    Circulatory compromise

    Hearing a hiss or rapid exit of the air

    the insertion of thoracostomy tube

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    Tension Pneuothorax cau

    Limit expansion of contralateral l

    May compromise venous return

    11

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    Definitive Treatment

    Closed thoracotomy:

    Drainage trapped air through a catheter

    External o enin in a de endent os

    12

    under wateradequate to re-expand thelung

    Open thoracotomy:

    Plicationof blebs

    Closure of fistula

    Stripping of the pleuraapical lung

    Thoracoscopy

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    Chemical pleurodesis:

    Talc

    Tetracycline

    Silver Nitrate

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    Pleural painanalgetic treatment:

    Codeine

    Morphine

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