Pneumothorax

PNEUMOTHORAKS Oleh : Mohd Mohd Ariff riff Hasr Hasree eenn

(110 (11010 1004 0445 45))

Herna Tri ! !lian"#

(110100$40)

A%rian# &ordias A' S

(110100$$)

ohanna Siho*+in,

(110100$$4)

-ifi -lorensia

(110100$0)

.eas# Handa#ani

(110100101)

Marina /" Sha*s!din

(11010041)

enni An,,raini

(11010010$)

Alief Eli" ohan

(11010010$)

He*alini Na,adei

(11010023)

 M!  M!"a**a*in Ula

(100100)

Pe*+i*+in, : dr' -ren,#

-a!l"as Kedo"eran Uniersi"as S!*a"era U"ara $015

ii

DAFTAR ISI

Hala*an BAB I: PENDAHULUAN .............................................................................

1

1'1 a"ar /elaan,'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1'$ R!*!san Masalah ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1' T!6!an Peneli"ian ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

1 1 $

BAB II: TINJAUAN PUSTAKA ...................................................................

3

$'1 .efinisi.................................................................................................

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$'$ E%ide*olo,i ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

4

$' Klasifiasi Pne!*o"oras /erdasaran Measnis*e Ke6adian '''''''''''

5

$''1 Pne!*o"oras S%on"an ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

5

$''1'1 Pne!*o"oras S%on"an Pri*er'''''''''''''''''''''''''''''''''''''''

5

$''1'$ Pne!*o"oras S%on"an Se!nder 77777'''''''''''''''



$''$ Pne!*o"oras Tra!*a"i '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

2

$''$'1 Pne!*o"oras Tra!*a"i a"ro,eni'''''''''''''''''''''''''''''

2

$''$'$ Pne!*o"oras Tra!*a"i Non a"ro,eni''''''''''''''''''''''

10

$'4 Klasifiasi Pne!*o"oras /erdasaran /erdasaran  6enis -is"!lan#a'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

11

$'4'1 Pne!*o"oras Ter"!"!%'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

11

$'4'$ Pne!*o"oras Ter+!a''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

11

$'4' Pne!*o"oras 8en"il'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

11

$'5 Pa"ofisiolo,i Pne!*o"oras ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

1$

$'9 .ia,nosis Pne!*o"oras''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

15

$'9'1 Kel!han ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

15

$'9'$ Pe*erisaan -isi'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

15

$'9' Pe*erisaan Pen!n6an,''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

19

$'3 Pena"alasanaan Pne!*o"oras ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

19

$'3'1 Pena"alasanaan Aal %ada Pne!*o"oras''''''''''''''''''''''''''''''''

19

$'3'$ Pena"alasanaan Pne!*o"oras Ter"!"!%''''''''''''''''''''''''''''''''''''

13

$'3' Pena"alasanaan Pne!*o"oras Ter+!a7'''''''''''''''''''''''''''''''''

13

$'3'4 Pena"alasanaan Tension Pne!*o"oras'''''''''''''''''''''''''''''''''''''

1

$'3'4'1 Needle Theora;os"o*#'''''''''''''''''''''''''''''''''''''''''''''''''''

1

$'3'4'$ Pe*asan,an &hes" T!+e'''''''''''''''''''''''''''''''''''''''''''''''''

1

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$' Ko*%liasi Pne!*o"oras ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

12

BAB III: PENUTUP………...........................................................................

21

'1 Kesi*%!lan''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

$1

DAFTAR PUSTAKA ....................................................................................

22

ii

0

BAB I PENDAHULUAN

1.1.

Latar Belakang

Pne!*o"oras didefinisian se+a,ai adan#a !dara a"a! ,as dala* ron,,a  %le!ra< #ai"!< di r!an, %o"ensial an"ara %le!ra iseral dan %arie"al %ar!=%ar!' Hasiln#a adalah ola%s dari %ar!=%ar! %ada sisi #an, "erena' Udara +isa *as! r!an, in"ra%le!ral *elal!i o*!niasi dari dindin, dada (#ai"!< "ra!*a) a"a! *elal!i %areni* %ar!=%ar! di  %le!ra i;eralis' Hasil dari "era%i %ada 40 %enderi"a den,an fra"!r *!l"i%le ;os"a dan dih!+!n,an %ada "ra!*a dada #an, "elah dianalisa' /erdasaran dari "ra!*a> 55 ($5<5?)  %asien %ne!*o"oras #an, +ere*+an, *en6adi 31 ($<?)=he*a"hora@< 20(41<3?)= he*o%ne!*o"oras' Tera%i onsera"if dari %ne!*o dan he*o"oras dala* +e+era%a as!s e+an#aan (+iasan#a dila!an "!s!an %ada ron,,a %le!ra< 6aran, dila!an draina,e)' Pada 43 %enderi"a #an, +erai"an den,an "ra!*a #an, den,an  forced position (%osisi se"en,ah d!d!)< /er"!6!an !n"! a"e"erisasi %ada ;a!* %le!ra den,an *en,,!naan s"ile""o "ro;ar *elen,!n, di+aah s!d!" 90 dera6a"' Pada "era%i ;lo""in, he*a"o"horas di,!naan s"re%"oinase #an, "er;a"a" +erefe %osi"if %ada 9 dari 3 %asien' ndiasi !n"! "orao"o*i di+a"asi %ada %asien den,an "ra!*a dada #an, +erh!+!n,an den,an sho; dan ehilan,an darah a!" (Re+e;;a /< $011)' 1.2.

R!"an #a"ala$

1' A%a e"iolo,i %ne!*o"orasB $' /a,ai*ana ;ara *ene,aan dia,nlosa %ne!*o"orasB ' /a,ai*ana %ena"alasanaan %ne!*o"orasB 4' A%a sa6a sa6a o*%liasi #an, da%a" "er6adi %ada %ne!*o"orasB 1. 3

T%an Penel&t&an

1' Un"! *en,e"ah!i e"iolo,i %ne!*o"oras'

1

$' Un"! da%a" *ene,aan dia,nosa %ne!*o"oras' ' Un"! *en,e"ah!i %en"alaasanaan %ne!*o"oras' 4' Un"! *en,e"ah!i o*%liasi #an, da%a" "er6adi %ada %ne!*o"oras'

BAB II TINJAUAN PUSTAKA

2

2.1 De'&n&"&

Pne!*o"oras adalah %en!*%!an !dara #an, +e+as dala* dada dil!ar %ar! #an, *en#e+a+an %ar! ola%s' Pne!*o"oras *er!%aan s!a"! ondisi di*ana "erda%a" !dara %ada a!*  %le!ra' Pada ondisi nor*al< ron,,a %le!ra "ida "erisi !dara sehin,,a %ar!=%ar! da%a" lel!asa *en,e*+an, "erhada% ron,,a dada' Udara dala* a!* %le!ra ini da%a" di"i*+!lan oleh : 1' Ro+en#a %le!ra iseralis sehin,,a saa" ins%irasi !dara #an, +erasal dari aleol!s aan *e*as!i a!* %le!ra' Pne!*o"oras 6enis ini dise+!" se+a,ai ;losed %ne!*o"oras' A%a+ila e+o;oran %le!ra iseralis  +erf!n,si se+a,ai a"!%< *aa !dara #an, *as! saa" ins%irasi "a aan da%a" el!ar dari a!* %le!ra %ada saa" es%irasi' Ai+a"n#a< !dara se*ain la*a se*ain +an#a sehin,,a *endoron, *edias"in!* earah on"rala"eral dan *en#e+a+an "er6adin#a "ension %ne!*o"oras' $' Ro+en#a dindin, dada dan %le!ra %arie"alis sehin,,a "erda%a" h!+!n,an an"ara a!* %le!ra den,an d!nia l!ar' A%a+ila l!+an, #an, "er6adi le+ih  +esar dari $C dia*e"er "raea< *aa !dara ;ender!n, le+ih *elea"i l!+an, "erse+!" di+andin, "ra"!s res%ira"ori!s #an, sehar!sn#a' Pada saa" ins%irasi< "eanan dala* ron,,a dada *en!r!n sehin,,a !dara dari l!ar  *as! e a!* %le!ra lea" l!+an, "adi dan *en#e+a+an ola%s %ada  %ar! i%sila"eral' Saa" es%irasi< "eanan ron,,a dada *enin,a"< ai+a"n#a !dara dari a!* %le!ra el!ar *elal!i l!+an, "erse+!"' Kondisi ini dise+!" se+a,ai o%en %ne!*o"oras (/er;< $010)' 2.2 E(&)e!&*l*g&

3

Pne!*o"oras da%a" dilasifiasian *en6adi %ne!*o"oras s%on"an dan "ra!*a"i' Pne!*o"oras s%on"an *er!%aan %ne!*o"oras #an, "er6adi "i+a= "i+a "an%a a"a! den,an adan#a %en#ai" %ar! #an, *endasari' Pne!*o"oras 6enis ini di+a,i la,i *en6adi %ne!*o"oras %ri*er ("an%a adan#a ria#a" %en#ai" %ar! #an, *endasari) *a!%!n se!nder ("erda%a" ria#a" %en#ai" %ar! se+el!*n#a)' nsidensin#a sa*a an"ara %ne!*o"oras %ri*er dan se!nder< na*!n  %ria le+ih +an#a "erena di+andin, ani"a den,an %er+andin,an 9:1' Pada %ria< resio %ne!*o"oras s%on"an aan *enin,a" %ada %eroo +era" di+andin, non  %eroo' Pne!*o"oras s%on"an serin, "er6adi %ada !sia *!da< den,an insidensi  %!n;a %ada deade e"i,a ehid!%an ($0=40 "ah!n)' Se*en"ara i"!< %ne!*o"oras "ra!*a"i da%a" dise+a+an oleh "ra!*a lan,s!n, *a!%!n "ida lan,s!n, %ada dindin, dada< dan dilasifiasian *en6adi ia"ro,eni *a!%!n non=ia"ro,eni' Pne!*o"oras ia"ro,eni *er!%aan "i%e

• • •

 %ne!*o"oras #an, san,a" serin, "er6adi (/er;< $010)' U*!r : /iasan#a "er6adi %ada oran, #an, +er !sia $0=40 "ah!n Ses : e+ih serin, %ada %ria Pne!*o"oras s%on"an %ri*er   /iasan#a "er6adi %ada ana lai=lai #an, "in,,i< !r!s dan !sia 10=0 

•

"ah!n nsidens %ada !sia "er"en"!: 3<4=1 as!s %er 100'000 oran, %er "ah!n

 %ada lai=lai 1<$=9 as!s %er 100'000 oran, %er "ah!n %ada %ere*%!an Pne!*o"oras s%on"an se!nder   U*!r : P!n;a e6adian di !sia 90=95 "ah!n insidensi 9< as!s %er  100'000 oran, %er "ah!n %ada lai=lai $<0 as!s %er 100'000 oran, %er  "ah!n %ada %ere*%!an $9 %er 100'000 %asien den,an %en#ai" %ar!

•

o+s"r!"if roni %er "ah!n (M;&ool -.< $00) Ke6adian %ne!*o"oras s%on"an %ri*er adalah 1 %er 100'000 oran, %er "ah!n

•

dan 9 %er 100'000 %ere*%!an %er "ah!nn#a' Hal ini "er6adi %alin, serin, di !sia $0=an< dan %ne!*o"oras s%on"an %ri*er 

•

 6aran, "er6adi di a"as !sia 40' Pne!*o"oras s%on"an se!nder +iasan#a "er6adi an"ara !sia 90 dan 95'

4

•

An"ara Tah!n 1221 dan 1225 "in,a" MRS di UK Hos%i"al +ai !n"!   %ne!*o"oras s%on"an %ri*er dan se!nder adalah 19<3 %er 100'000 oran, %er 

•

"ah!n dan 5< %er 100'000 %ere*%!an %er "ah!n' Re!rensi aan "er6adi %ada sei"ar 0? dari 45? %ri*er dan se!nder   %ne!*o"oras' Hal ini serin, "er6adi dala* 9 +!lan< dan +iasan#a dala* a"!  "ah!n' (Koro*' S< $011)

2.3

Kla"&'&ka"& Pne!*t*rak" Ber)a"arkan #ekan&"!e Ke%a)&an

2.3.1 Pne!*t*rak" "(*ntan 2.3.1.1 Pne!*t*rak" S(*ntan Pr&!er

Pne!*o"oras ini *er!%aan %ne!*o"oras #an, "er6adi %ada %ar!=%ar! #an, seha" dan "ida ada %en,ar!h dari %en#ai" #an, *endasari' An,a e6adian  %ne!*o"oras s%on"an %ri*er (PSP) sei"ar 1=$ %er 100'000 %ria %er"ah!n dan 1<$=9  %er 100'000 ani"a %er"ah!n (Ma;enDie and ra#< $003)' U*!*n#a< e6adian ini "er6adi  %ada oran, +er"!+!h "in,,i< !r!s< dan +er!sia an"ara 1=40 "ah!n' Meanis*e #an, did!,a *endasari "er6adin#a PSP adalah r!%"!r +le+ s!+%le!ra %ada a%es %ar!=%ar! (Heffner and H!,,ins< $004)' Udara #an, "erda%a" di r!an, in"ra%le!ra "ida didah!l!i oleh "ra!*a< "an%a diser"ai elainan linis dan radiolo,is' Na*!n +an#a %asien #an, din#a"aan *en,ala*i PSP *e*%!n#ai %en#ai" %ar!=%ar! s!+linis' Ria#a" el!ar,a den,an e6adian ser!%a dan e+iasaan *eroo *enin,a"an resio "er6adin#a  %ne!*o"oras ini (Heffner and H!,,ins< $004)' -a"or #an, saa" ini did!,a +er%eran dala* %a"o,enesis PSP adalah "erda%a" se+a,ian %areni* %ar!=%ar! #an, *enin,a" %orosi"asn#a' Penin,a"an %orosi"as *en#e+a+an e+o;oran !dara iseral den,an a"a! "an%a %er!+ahan e*fise*a"o!s %ar!=  %ar!' H!+!n,an "in,,i +adan den,an %enin,a"an resio "er6adin#a PSP adalah arena ,radien "eanan %le!ra *enin,a" dari dasar e a%es %ar!' Ai+a"n#a< aleoli %ada a%es  %ar!=%ar! oran, +er"!+!h "in,,i ren"an "erhada% *enin,a"n#a "eanan #an, da%a" *endah!l!i %roses %e*+en"!an is"a s!+%le!ra (Ma;enDie and ra#< $003)'

5

PSP !*!*n#a da%a" di"oleransi den,an +ai oleh %enderi"an#a arena "ida  adan#a %en#ai" %ar!=%ar! #an, *endasari (Heffner and H!,,ins< $004)' Pada se+a,ian  +esar as!s PSP< ,e6ala aan +er!ran, a"a! hilan, se;ara s%on"an dala* $4=4 6a*' Ke;e%a"an a+sor%si s%on"an !dara dari ron,,a %le!ra sei"ar 1<$5=1<? dari ol!*e he*i"oras %er hari< dan s!%le*en"asi osi,en se+esar 10 l%* aan *enin,a"an e;e%a"an a+sor%si sa*%ai den,an e*%a" ali li%a" (Ma;enDie and ra#< $003)' /e+era%a *a;a* "era%i #an, da%a" dila!an %ada %asien PSP an"ara lain o+serasi< drainase in"eros"al den,an a"a! "an%a %le!rodesis< dan video-assisted thoracoscopic  surgery (8ATS) (Heffner and H!,,ins< $004)'

Pand!an "era%i !n"! PSP diel!aran oleh  British Thoracic Society  (/TS) dan  American College of Chest Physician  (A&&P)' Terda%a" %er+edaan !n"! +esar= e;iln#a %ne!*o"oras dan 6enis "era%i !n"! PSP e;il si*"o*a"i dan PSP si*"o*a"i  #an, s"a+il di an"ara ed!an#a (Ma;enDie and ra#< $003)' /eri!" adalah rin,asan ,a+!n,an %and!an "era%i *en!r!" /TS dan A&&P (Ma;enDie and ra#< $003)' a. Clinically stable small pneumotoraks

Ked!a %and!an *en#a"aan "era%i !n"! %asien s"a+il den,an  %ne!*o"oras e;il (F$ ;*< /TS> F ;*< A&&P) dan ,e6ala *ini*al adalah den,an *ela!an o+serasi dan di=KRS=an' Pand!an A&&P *en#aranan dila!ann#a o+serasi sei"ar =9 6a*< fo"o ron",en %ar!=  %ar!< diKRSan den,an ins"r!si len,a%< dan %asien di*in"a !n"!  on"rol dala* d!a hari +eri!"n#a' b. Large pneumotoraks and symptomatic small pneumotoraks

Pasien #an, "er,olon, dala* PSP ini *e*+!"!han in"erensi' /TS *ereo*endasian as%irasi sederhana se+a,ai "era%i lini %er"a*a %ada PSP l!as den,an ondisi s"a+il dan %ne!*o"oras e;il si*"o*a"is' &GR  dila!an se"elah as%irasi !n"! *enen"!an a%aah "erda%a" %er+aian' A%a+ila "ida ada %er+aian a"a! %asien *asih si*"o*a"is dan 6!*lah as%irasi aal !ran, dari $<5 li"er as%irasi !lan,an da%a" dila!an'

6

A%a+ila as%irasi %er"a*a s!dah le+ih dari $<5 li"er a"a! as%irasi !lan,an "ida +erhasil *aa %e*asan,an drain in"eros"al har!s dila!an' c.

Clinically unstable patients ith a large pneumotoraks

Pada %asien #an, "er*as! dala* a"e,ori ini se+ain#a dila!an  %e*asan,an drain in"eros"al dan di=MRS=an' Par!=%ar! har!s da%a" *en,e*+an, se%en!hn#a $4 6a* se+el!* drain dile%as' &GR dila!an se"ia% $4 6a*' d. Surgical intervention

Tera%i %e*+edahan har!s *!lai di%iiran a%a+ila "erda%a" e+o;oran !dara %ersis"en a"a! %ar!=%ar! ,a,al *ela!an re=es%ansi se"elah =5 hari'ndiasi dila!ann#a o%erasi *eli%!"i "er6adin#a %ne!*o"oras i%sila"eral #an, ed!a< %ne!*o"oras on"rala"eral #an, %er"a*a< dan adan#a resio %eer6aan se%er"i %en#ela* a"a! %ilo"' Pasien den,an  %rofesi "erse+!" se+ain#a *en6alani "indaan o%erasi +ila"eral' Pilihan "era%i %e*+edahan #an, da%a" dila!an se%er"i  !ATS" pleural abrasion"  surgical

talc

pleurodesis"

pleurectomy<

dan

open

thoracostomy

#$acken%ie and &ray" '(()*

Pada %e*asan,an drain in"eros"al< !!ran a"e"er %le!ra "ida *e*%en,ar!hi efe"ii"as drainase %ada "era%i PSP' Selain i"!< "ida ada orelasi an"ara !!ran drainase dan "in,a" o*%liasi< re!rensi< dan la*an#a %asien diraa"' Na*!n a"e"er den,an dia*e"er e;il "ida da%a" di,!naan a%a+ila "erda%a" ;airan %le!ra (arena da%a" *en#!*+a") dan adan#a e+o;oran !dara (*en#e+a+an rees%ansi #an, "ida ade!a")' Suction han#a da%a" di%er"i*+an,an 4 6a* se"elah %e*asan,an drainase !n"! 

*en,!ran,i resio "er6adin#a ede*a re=es%ansi %ar!=%ar! dan har!s dions!lan e%ada do"er ahli %ar!' /TS *ereo*endasian sis"e*  suction den,an ol!*e +esar dan "eanan rendah (=10 "o =$0 ;* H$O)' .rainase se+ain#a "ida di6e%i" e;!ali di*in"a oleh ahli %ar! a"a! s%esialis +edah TK8' Pen6e%i"an drainase da%a" +er+aha#a dan "ida  ada +!"i #an, *en!n6!an %enin,a"an an,a e+erhasilan a"a! %en!r!nan resio

7

re!rensi' ndiasi %en6e%i"an drainase adalah a%a+ila "erda%a" e+o;oran !dara "er!s *ener!s arena +er%o"ensi *en#e+a+an tension pneumotoraks'

2.3.1.2 Pne!*t*rak" S(*ntan Sekn)er

PSS *er!%aan %ne!*o"oras #an, "er6adi %ada %asien den,an %en#ai" %ar! #an, *endasari' U*!*n#a PSS "er6adi se+a,ai o*%liasi &OP.< fi+rosis is"i< "!+er!losis<  pneumocystitis  %ne!*onia< dan *ens"r!asi' PSS 6!,a da%a" "er6adi ada  %en#ai" in"ersisial %ar! se%er"i  sarcoidosis< lymphangioleiomyomatosis< langerhans cell  histiocytosis  and tuberous sclerosis. Se;ara !*!* !dara %ada PSS *e*as!i ron,,a

 %le!ra *elal!i aleoli #an, *ele+ar a"a! r!sa' Per+!r!an linis dan  se+uelae +iasan#a "er6adi ai+a" adan#a ondisi o*or+id' Causa "er+an#a PSS adalah &OP.< h!s!sn#a &OP. sedan,=+era"' A%a+ila

 %ne!*o"oras "er6adi %ada %asien &OP.< ,e6ala sesa na%as #an, %ro,resif *!n;!l dan  +iasan#a +ersa*aan den,an n#eri %le!ri"i' PSS *er!%aan %enanda si,nifian !n"!  *or"ali"as %asien &OP.' Se"ia% e6adian %ne!*o"oras *enin,a"an resio e*a"ian sa*%ai den,an e*%a" ali li%a"' Sei"ar 40=50? %asien aan *en,ala*i PSS #an, ed!a a%a+ila %le!rodesis "ida dila!an (Heffner and H!,,ins< $004)' Un"! %enan,an PSS< A&&P *ereo*endasian %e*asan,an chest tube !n"!  se"ia% %asien PSS< dan %le!rodesis %ada e%isode %er"a*a PSS ,!na *en;e,ah re!rensi' Sedan,an reo*endasi /TS *ereo*endasian as%irasi den,an  syringe  dan a"e"er  !n"! %asien %ne!*o"oras e;il den,an %en#ai" %ar! #an, *endasari rin,an' Se+a,ian  +esar %asien *e*+!"!han drainase *elal!i chest tube' Pele%asan ;hes" "!+e dila!an se"elah "er6adi re=es%ansi %ar! dan resol!si e+o;oran !dara' Ple!rodesis *er!%aan "era%i %ilihan "erahir dan dila!an %ada %asien den,an e+o;oran !dara #an, "ida  "era"asi dan *en,ala*i %ne!*o"oras re!ren (Ma;enDie and ra#< $003)'

2.3.2

Pne!*t*rak" Tra!at&k 

8

2.3.2.1 Pne!*t*rak" Tra!at&k Iatr*gen&k 

Pne!*o"oras ia"ro,eni *er!%aan %ne!*o"oras #an, "er6adi ai+a"  %e*+!aan ron,,a %ar! se;ara %asa saa" "indaan dia,nosis a"a! "era%i inasif  dila!an' Tindaan se%er"i thoracocentesis< +io%si %le!ra< %e*asan,an a"e"er ena sen"ral< +io%si %ar! %er!"an< +ronoso%i den,an +io%si "rans+ronial< as%irasi transtoracic< dan en"ilasi "eanan %osi"if da%a" *en6adi e"iolo,in#a' Ai+a"n#a< %asien

 %erl! le+ih la*a diraa" di r!*ah sai" (il*aD< e" al< $00$)' Pen#e+a+ !"a*a "er6adin#a %ne!*o"oras ia"ro,eni adalah as%irasi 6ar!* hal!s transthoracic' .!a fa"or #an, *e*e,an, %eran, %en"in, adalah !!ran dan edala*an lesi' A%a +ila lesi e;il dan dala* *aa resio %ne!*o"oras *enin,a"' Pen#e+a+ ed!a "er+an#a adalah %e*asan,an a"e"er ena sen"ral' Pen#e+a+ lainn#a an"ara lain a!%!n"!r transthoracic< res!si"asi 6an"!n,=%ar!< dan %en#alah,!naan o+a" *elal!i ena leher (Shar*a< $002)'

2.3.2.2 Pne!*t*rak" Tra!at&k N*n Iatr*gen&k 

Pne!*o"oras 6enis ini "er6adi ai+a" "ra!*a "!*%!l a"a! "a6a* #an, *er!sa   %le!ra iseralis a"a! %arie"alis' Pada "ra!*a "a6a*< l!a *en#e+a+an !dara da%a" *as!  e ron,,a %le!ra lan,s!n, e dindin, "oras a"a! *e*en!6! %le!ra iseralis *elal!i ;a+an,=;a+an, "raeo+ronial' !a "!s! a"a! l!a "e*+a se;ara lan,s!n, *el!ai  %ar!=%ar! %erifer *en#e+a+an "er6adin#a he*o"horas dan %ne!*o"oras di le+ih dari 0? lesi di dada ai+a" +enda a6a* (Shar*a< $002)' Pada "ra!*a "!*%!l %ne!*o"oras "er6adi a%a+ila %le!ra iseralis r!sa ai+a" fra"!r a"a! disloasi os"a' Ko*%resi dada se;ara "i+a="i+a *en#e+a+an %enin,a"an "eanan aleolar se;ara "a6a* dan e*!dian "er6adi r!%"!r aleoli' Saa" aleoli r!%"!r  !dara *as! e ron,,a in"ersisial dan "er6adi disesi *en!6! %le!ra iseralis a"a! *edias"in!*' Pne!*o"oras "er6adi saa" "er6adi r!%"!r %ada %le!ra iseralis a"a! *edias"in!* dan !dara *as! e ron,,a %le!ra' Manifes"asi linisn#a da%a" +er!%a

9

 ,allen lung signpeptic lung sign  di *ana hil!s %ar! "erle"a le+ih rendah dari nor*al

a"a! "erda%a" %ne!*o"oras %ersis"en den,an chest tube "er%asan, dan +erf!n,si den,an  +ai (Shar*a< $002)' Pne!*o"oras "ra!*a"i nonia"ro,eni 6!,a da%a" "er6adi ai+a" +aro"ra!*a' Pada s!h! ons"an< ol!*e *assa !dara +er+andin, "er+ali den,an "eanann#a< sehin,,a a%a+ila di"e*%a"an %ada e"in,,ian 050 *< ol!*e !dara #an, "ersa"!rasi  %ada "!+!h *enin,a" 1<5 ali li%a" dari%ada saa" di e"in,,ian %er*!aan la!"' Pada  %enin,a"an "eanan "erse+!"< !dara #an, "er6e+a dala* +le+ da%a" *en,ala*i r!%"!r  dan *en#e+a+an %ne!*o"oras' Hal ini +iasan#a "er6adi %ada r! %esaa" "er+an,' Sedan,an %ada %en#ela*< !dara #an, "ero*%resi dialiran e %ar!=%ar! har!s *elal!i re,!la"or dan sea"! nai e %er*!aan +aro"ra!*a da%a" "er6adi seirin, den,an  %en!r!nan "eanan se;ara ;e%a" sehin,,a !dara #an, "erda%a" di %ar!=%ar! da%a" *en#e+a+an %ne!*o"oras (Shar*a< $002)

2.+ Kla"&'&ka"& Pne!*t*rak" Ber)a"arkan Jen&" F&"tlan,a 2.+.1 Pne!*t*rak" Tertt( - Simple Pneumothorax 

Pada "i%e ini< %le!ra dala* eadaan "er"!"!% ("ida ada 6e6as "er+!a %ada dindin, dada)< sehin,,a "ida ada h!+!n,an den,an d!nia l!ar' Teanan di dala* ron,,a  %le!ra aaln#a *!n,in %osi"if< na*!n la*+a" la!n +er!+ah *en6adi ne,a"if  arena disera% oleh 6arin,an %ar! disei"arn#a' Pada ondisi "erse+!" %ar! +el!* *en,ala*i rees%ansi< sehin,,a *asih ada ron,,a %le!ra< *esi%!n "eanan di dala*n#a s!dah e*+ali ne,a"if'Pada a"! "er6adi ,eraan %erna%asan< "eanan !dara di ron,,a %le!ra "e"a% ne,a"if' Misal "erda%a" ro+ean %ada %le!ra iseralis dan %ar! a"a! 6alan nafas a"a! esofa,!s< sehin,,a *as! a!* %le!ra arena "eanan a!* %le!ra ne,a"if (Alsa,aff< $002)' 2.+.2 Pne!*t*rak" Ter/ka -Open Pneumothorax 

Pne!*o"oras "er+!a #ai"! %ne!*o"oras di*ana "erda%a" h!+!n,an an"ara ron,,a %le!ra den,an +ron!s #an, *er!%aan +a,ian dari d!nia l!ar arena "erda%a" l!a "er+!a %ada dada' .ala* eadaan ini "eanan in"ra%le!ra sa*a

10

den,an "eanan !dara l!ar' Pada %ne!*o"oras "er+!a "eanan in"ra%le!ra sei"ar  nol' Per!+ahan "eanan ini ses!ai den,an %er!+ahan "eanan #an, dise+a+an oleh ,eraan %erna%asan'Pada saa" ins%irasi "eanan *en6adi ne,a"if dan %ada a"! es%irasi "eanan *en6adi %osi"if'Selain i"!< %ada saa" ins%irasi *edias"in!* dala * eadaan nor*al< "e"a%i %ada saa" es%irasi *edias"in!* +er,eser e arah sisi dindin, dada #an, "erl!a ( sucking ound ) (Alsa,aff< $002)' 2.+.3 Pne!*t*rak" 0ent&l -Tension Pneumothorax 

Pne!*o"oras en"il adalah %ne!*o"oras den,an "eanan in"ra%le!ra #an, %osi"if  dan *ain la*a *ain +er"a*+ah +esar arena ada fis"el di %le!ra iseralis #an,  +ersifa" en"il' Pada a"! ins%irasi !dara *as! *elal!i "raea< +ron!s ser"a  %er;a+an,ann#a dan selan6!"n#a "er!s *en!6! %le!ra *elal!i fis"el #an, "er+!a' a"! es%irasi !dara di dala* ron,,a %le!ra "ida da%a" el!ar' Ai+a"n#a "eanan di dala* ron,,a %le!ra *ain la*a *ain "in,,i dan *ele+ihi "eanan a"*osfer'Udara #an, "er!*%!l dala* ron,,a %le!ra ini da%a" *enean %ar! sehin,,a serin, *eni*+!lan ,a,al na%as (Alsa,aff< $002)' 2.

Pat*'&"&*l*g& Pne!*t*rak"

Pne!*o"oras dilasifiasian a"as %ne!*o"oras s%on"an< "ra!*a"i< ia"ro,eni' Pne!*o"oras s%on"an di+a,i la,i *en6adi %ne!*o"oras s%on"an %ri*er dan se!nder' Pne!*o"oras "ra!*a"i dise+a+an oleh "ra!*a %ada or,an %ar! dan  %ne!*o"oras ia"ro,eni *er!%aan o*%liasi dari in"erensi dia,nos"i a"a!%!n "era%e!"i' Pne!*o"oras s%on"an %ri*er "er6adi "an%a elainan a"a! %en#ai" %ar! #an, *endasarin#a< na*!n %ada se+!ah %eneli"ian dila%oran +aha +!la s!+%le!ral di"e*!an %ada 39=100? %asien %ne!*o"oras s%on"an %ri*er den,an "indaan ideo= assis"ed "hora;os;o%i; s!r,er# dan "orao"o*i' Kas!s %ne!*o"oras s%on"an %ri*er  serin, dih!+!n,an den,an fa"or resio *eroo #an, *endasari %e*+en"!an +!la s!+%le!ral< na*!n %ada se+!ah %eneli"ian den,an o*%!"asi "o*o,rafi (&T=s;an)

11

*en!n6!an +aha 2? as!s den,an +!la s!+%le!ral adalah %eroo +er+andin, den,an 1? as!s adalah +!an %eroo' Meanis*e %e*+en"!an +!la *asih *er!%aan s%e!lasi na*!n se+!ah "eori *en6elasan +aha "er6adi de,radasi sera" elas"in %ar! #an, diind!si oleh roo  #an, e*!dian dii!"i oleh ser+!an ne!"rofil dan *arofa,' Proses ini *en#e+a+an e"idasei*+an,an

%ro"ease=an"i%ro"ease

dan

sis"e*

osidan=an"iosidan

ser"a

*en,ind!si "er6adin#a o+s"r!si sal!ran nafas ai+a" %roses infla*asi' Hal ini aan *enin,a"an "eanan aleolar sehin,,a "er6adi e+o;oran !dara e 6arin,an in"ers"i"ial  %ar! *en!6! hil!s dan *en#e+a+an %ne!*o*edias"in!*' "eanan di *edias"in!* aan *enin,a" dan %le!ra %arie"alis %ars *edias"in!* r!%"!r sehin,,a "er6adi %ne!*o"oras' Ron,,a %le!ra *e*ilii "eanan ne,a"if< sehin,,a +ila ron,,a ini "erisi oleh !dara ai+a" r!%"!rn#a +!la s!+%le!ral< %ar!=%ar! aan ola%s sa*%ai "er;a%ain#a esei*+an,an "eanan "er;a%ai a"a! +a,ian #an, r!%"!r "erse+!" di"!"!%' Par!=%ar! aan  +er"a*+ah e;il den,an +er"a*+ah l!asn#a %ne!*o"oras' Konse!ensi dari %roses ini adalah "i*+!ln#a sesa ai+a" +er!ran,n#a a%asi"as i"al %ar! dan "!r!nn#a PO$' Se+!ah %eneli"ian lain *en!n6!an +aha fa"or ,ene"i +er%eran dala*  %a"o,enesis "er6adin#a %ne!*o"oras s%on"an %ri*er' /e+era%a as!s %ne!*o"oras s%on"an %ri*er di"e*!an %ada elainan ,ene"i "er"en"!< se%er"i: sindro* *arfan< ho*osis"ein!ria< ser"a sindro* /ir"=Ho,,=.!+e' Pne!*o"oraas s%on"an se!nder "er6adi ai+a" elainanC%en#ai" %ar! #an, s!dah ada se+el!*n#a' Meanis*e "er6adin#a adalah ai+a" %enin,a"an "eanan aleolar  #an, *ele+ihi "eanan in"ers"i"ial %ar!' Udara dari aleol!s aan +er%indah e in"ers"i"ial *en!6! hil!s dan *en#e+a+an %ne!*o*edias"in!*' Selan6!"n#a !dara aan +er%indah *elal!i %le!ra %arie"alis %ars *edias"inal e ron,,a %le!ra dan *eni*+!lan  %ne!*o"oras' /e+era%a %en#e+a+ "er6adin#a %ne!*o"oras s%on"an se!nder adalah: •

Pen#ai" sal!ran na%as

12

•

o

&OP.

o

Kis"i fi+rosis

o

As*a +ronial

Pen#ai" infesi %ar! Pne!*o;#s"i; ;arinii %ne!*onia

o

o

 ecroti%ing  %ne!*onia (infesi oleh !*an anaero+i< +a"eri ,ra* ne,a"if 

a"a! s"a%h#loo!s) •

•

•

•

Pen#ai" %ar! in"ers"i"ial o

Saroidosis

o

-i+rosis %ar! idio%a"i 

o

ran!lo*a"osis sel lan,erhans

o

i*fan,iolei*io*a"o!s

o

Slerosis "!+er!s

Pen#ai" 6arin,an %en#a*+!n, o

Ar"ri"is rhe!*a"oid

o

S%ondili"is anilosin,

o

Poli*iosi"is dan der*a"o*iosis

o

Sleroder*a

o

Sindro* Marfan

o

Sindro* E"hers=.anlos

Kaner  o

Saro*a

o

Kaner %ar!

Endo*e"riosis "orasis

13

Pne!*o"oras "ra!*a"i da%a" dise+a+an oleh "ra!*a %ene"rasi *a!%!n non=  %ene"rasi' Tra!*a "!*%!l a"a! on"!sio %ada dindin, dada 6!,a da%a" *eni*+!lan  %ne!*o"oras' /ila "er6adi %ne!*o"oras< %ar! aan *en,e*%es arena "ida ada la,i "arian e l!ar dindin, dada' Pen,e*+an,an dindin, dada %ada saa" ins%irasi "ida dii!"i den,an %en,e*+an,an %ar! #an, +ai a"a! +ahan %ar! "ida *en,e*+an, sa*a seali' Teanan %le!ra #an, nor*aln#a ne,a"if aan *enin,a" hin,,a *en#e+a+an ,an,,!an en"ilasi %ada +a,ian #an, *en,ala*i %ne!*o"oras' Pne!*o"oras ia"ro,eni *er!%aan o*%liasi dari %rosed!r *edis a"a!  +edah' Salah sa"! #an, %alin, serin, adalah ai+a" as%irasi "rans"orai ( transthoracic needle aspiration)< "oraosen"esis< biopsy "rans+ronial< en"ilasi *eani "eanan %osi"if 

( positive pressure mechanical ventilation)'An,a e6adian as!s %ne!*o"oras *enin,a" a%a+ila dila!an oleh linisi #an, "ida +er%en,ala*an' Pne!*o"oras en"il (tension %ne!*o"oras) "er6adi ai+a" ;edera %ada  %areni* %ar! a"a! +ron!s #an, +er%eran se+a,ai a"!% searah' Ka"!% ini *en,ai+a"an !dara +er,era searah e ron,,a %le!ra dan *en,halan,i adan#a aliran  +ali dari !dara "erse+!"' Pne!*o"oras en"il +iasa "er6adi %ada %eraa"an in"ensif #an, da%a" *en#e+a+an "er%eran,a%n#a !dara en"ila"or (en"ilasi *eani "eanan %osi"if) di ron,,a %le!ra "an%a adan#a aliran !dara +ali' Udara #an, "er%eran,a% aan *enin,a"an "eanan %osi"if di ron,,a %le!ra sehin,,a *enean *edias"in!* dan *endoron, 6an"!n, ser"a %ar! e arah on"rala"eral' Hal ini *en#e+a+an "!r!nn#a ;!rah 6an"!n, dan "i*+!ln#a hi%osia' &!rah 6an"!n, "!r!n arena venous return  e 6an"!n, +er!ran,< sedan,an hi%osia "er6adi ai+a" ,an,,!an %er"!aran !dara %ada %ar! #an, ola%s dan %ar! #an, "er"ean di sisi on"rala"eral' Hi%osia dan "!r!nn#a ;!rah 6an"!n, aan *en,,an,! es"a+ilan he*odina*i #an, aan +erai+a" fa"al 6ia "ida di"an,ani se;ara "e%a"'

2.

D&agn*"&" Pne!*t*rak"

14

2..1

Kel$an

a) N#eri dada he+a" #an, "i+a="i+a %ada sisi %ar! "erena h!s!sn#a %ada  +)

saa" +ernafas dala* a"a! +a"!' Sesa< da%a" sa*a%ai +era"< adan, +isa hilan, dala* $4 6a*< a%a+ila

se+a,ian %ar! #an, ola%s s!dah *en,e*+an, e*+ali ;) M!dah lelah %ada saa" +era"ifi"as *a!%!n +eris"iraha"' d) arna !li" #an, e+ir!an dise+a+an arena !ran,n#a osi,en (sianosis) 2..2

Pe!er&k"aan F&"&k 

a) ns%esi: da%a" "er6adi %en;e*+!n,an dan %ada a"! %er,eraan nafas< "er"in,,al %ada sisi #an, sai"  +) Pal%asi: Pada sisi #an, sai" r!an, sela i,a da%a" nor*al a"a! *ele+ar< i"!s 6an"!n, "erdoron, esisi "horas #an, seha"' -re*i"!s s!ara *ele*ah a"a! *en,hilan,' ;) Per!si: S!ara e"o hi%ersonor sa*a%i "#*%ani dan "ida +er,e"ar<  +a"as 6an"!n, "erdoron, e "horas #an, seha"< a%a+ila "eanann#a "in,,i d) A!s!l"asi: s!ara nafas *ele*ah sa*%ai *en,hilan,< nafas da%a" a*fori  a%a+ila ada fis"el #an, ;!!% +esar  2..3

Pe!er&k"aan Penn%ang

a) Radiolo,is: /. Ta*%a +a#an,an hi%erl!sen +ai +ersifa" loal *a!%!n ,eneral '. Pada ,a*+aran hi%erl!sen ini "ida "a*%a 6arin,an %ar!< 6adi aas!ler' 0. /ila %ne!*o"oras he+a" seali da%a" *en#e+a+an "er6adin#a ola%s dari %ar!= %ar! sei"arn#a< sehin,,a *assa 6arin,an %ar! #an, "erdesa  ini le+ih %ada" den,an densi"as se%er"i +a#an,an "!*or' 1. /iasan#a arah ola%s e *edial 2. /ila he+a" seali da%a" *en#e+a+an "er6adin#a %erdoron,an %ada  6an"!n, *isaln#a %ada %ne!*o"oras en"il a"a! a%a #an, i"a enal se+a,ai tension pneumothora3 4. !,a *edias"in!* dan "raea da%a" "erdoron, esisi #an, +erlaanan'  +) /A: !n"! *e*erisa adar osi,en dala* darah %asien 2.. Penatalak"anaan Pne!*t*rak" 2..1 Penatalak"anaan A4al (a)a Pne!*t*rak"

Pena"alasanaan aal %ada se*!a %asien "ra!*a adalah dila!an s"a+ilisasi leher hin,,a di%as"ian %asien "ida *en,ala*i ;edera serial den,an ;ara *e*asan, cervical collar   a"a! den,an an"on, +erisi %asir' Eal!asi "in,a" esadaran den,an

*en#a%a %asien dan dilan6!"an den,an %e*erisaan A/& ( airay" breathing" circulation* (/oon< $00)'

15

Pada %e*erisaan 6alan nafas #ai"! *e*+!a 6alan nafas den,an  5a thrust (+ila di;!ri,ai "erda%a" ;edera serial %ada %asien "ida sadar)

a"a! head tilt chin lift 

dilan6!"an den,an *e*+ersihan ron,,a *!l!" den,an sa+ *en,!naan 6ari "el!n6!< *e*%er"ahanan 6alan nafas a,ar "e"a% "er+!a' Pada %asien "ida sadar dila!an  %e*asan,an orofarin,eal tube  !n"! *en;e,ah lidah 6a"!h dan *en!"!% 6alan nafas (/oon< $00)' Pe*erisaan %ernafasan #ai"! *eliha"< *enden,ar< dan *erasaan dila!an se;ara +ersa*aan' Pada %asien den,an %ne!*o"oras %ere*+an,an dindin, dada asi*e"ris< deiasi "raea e %ar! #an, seha"< 8P *enin,a"< s!ara nafas *en!r!n  +ahan *en,hilan, dan %ada %er!si dida%a"an hi%ersonor' /ila dida%a"an "anda="anda "erse+!"< lan,s!n, dila!an "indaan needle thoracostomy (/oon< $00)' Pe*erisaan nadi aro"is dan radialis dida%a"an "aiardi< aral dan *e*erisa capillary refill time' .ila!an %e*asan,an intravenous line< +ila "er6adi %erdarahan

*asif dila!an %e*asan,an double line den,an ;airan ris"aloid (/oon< $00)' 2..2 Penatalak"anaan Pne!*t*rak" Tertt( - Simple Pneumothorax)

Ke+an#aan as!s  simple pneumothoraces  aan *e*+!"!han %e*asan,an intercostal chest drain  se+a,ai "era%i defini"if'  Pneumothoraces  e;il< h!s!sn#a #an,

han#a "erliha" den,an *en,,!naan ,a*+aran "o*o,rafi o*%!"er' Pe*asan,an ;hes" tube  ;o;o %ada as!s #an, "erda%a" multiple in5ury< %asien #an, *en6alani anes"esia

#an, +ere%an6an,an< a"a! %asien #an, aan di"ransfer den,an 6ara #an, 6a!h di*ana de"esi %enin,a"an a"a! tension pneumothora3   *!n,in s!li" a"a! "er"!nda (/rohi< $004)'

2..3 Penatalak"anaan Pne!*t*rak" Ter/ka - Open Pneumothorax 

Osi,en har!s di+erian *elal!i  facemask ' n"!+asi har!s di%er"i*+an,an  +ila osi,enasi a"a! en"ilasi "ida ade!a"' n"!+asi "ida +oleh *en!nda %e*asan,an chest tube  dan %en!"!%an l!a' Mana6e*en defini"if %ada open pneumotoraks   adalah

*en!"!% l!a dan se,era *e*asan, intercostal chest drain (/rohi< $004)'

16

/ila chest drain "ida "ersedia dan %asien 6a!h dari fasili"as #an, +isa *ela!an "era%i defini"if %er+an da%a" dile"aan di a"as l!a dan di%les"er %ada "i,a sisin#a' Se;ara "eori< hal "erse+!" +er"inda se+a,ai a"!%=fla% !n"! *e*!n,inan !dara el!ar dari %ne!*o"oras sela*a es%irasi< na*!n "ida *as! sela*a ins%irasi' Hal ini *!n,in s!li" +ila dila!an %ada l!a #an, l!as dan efen#a san,a" +erariasi' Sese,era *!n,in chest drain har!s di%asan, dan l!a di"!"!% (/rohi< $004)'

2..+ Penatalak"anaan Tension Pneumothorax  2..+.1 Needle Thoracostomy

Mana6e*en lasi tension pneumothora3 adalah deo*%resi dada den,an needle toracostomy' ar!* !!ran 14=19  di"!s!an %ada  6ntercostal Space (&S)   $id Clavicular Line (M&)' ar!* di%er"ahanan hin,,a !dara da%a" diel!aran

*elal!i s%!i" #an, "erh!+!n, den,an 6ar!*' ar!* di"ari dan an!l di+iaran "er+!a di !dara' Udara #an, el!ar den,an ;e%a" dari dada *en!n6!an adan#a tension  pneumothora3'

Man!er ini *en,!+ah tension pnemothora3  *en6adi  simple

 pneumothora3 (/rohi< $004)' 2..+.2 Pe!a"angan Chest Tube

Pe*asan,an chest tube *er!%aan "era%i defini"if %ada tension pnemothora3 ' Chest tube har!s "ersedia den,an ;e%a" di r!an, res!si"asi dan %e*asan,annn#a +iasan#a

;e%a"' Pe*asan,an "eron"rol chest tube le+ih +ai !n"! blind needle thoracostomy ' Hal ini *en#e+a+an s"a"!s res%ira"ori dan he*odina*i %asien aan *enoleransi +e+era%a *eni" "a*+ahan !n"! *ela!an  surgical

thoracostomy. Se"elah %le!ra di*as!i

(disesi "!*%!l)< "eanan aan dideo*%resi dan %e*asan,an chest tube da%a" dila!an "an%a "er+!r!=+!r!' Hal ini "er!"a*a +erla! +a,i %asien #an, "eren"ilasi *an!al den,an "eanan %osi"if (/rohi< $004)'

17

2.5 K*!(l&ka"& Pne!*t*rak"

Ko*%liasi #an, da%a" "er6adi %ada %ne!*o"oras an"ara lain adalah  %ne!*o*edias"in!* dan e*fise*a s!+!"is' Pne!*o*edias"in!* da%a" "er6adi *elal!i "i,a "aha% #an, !*!* dise+!" den,an efe Ma;lin' Ur!"an e6adiann#a adalah "er6adin#a r!%"!r aleolar e*!dian "er6adi disesi se%an6an, se!+!n, +ronoas!ler  *en!6! daerah hil!s dan ahirn#a !dara *en;a%ai *edias"in!*' Pne!*o*edias"in!*  6aran, *en#e+a+an o*%liasi linis #an, si,nifian' Te"a%i %ada +e+era%a as!s< "ension %ne!*o*edias"in!* da%a" *en#e+a+an %enin,a"an "eanan *edias"in!* sehin,,a "er6adi %eneanan lan,s!n, "erhada% 6an"!n, a"a! *en!r!nan aliran darah  +ali sehin,,a "er6adi %en!r!nan ;!rah 6an"!n,' Pne!*o*edias"in!* da%a" +ere*+an, *en6adi e*fiese*a s!+!"is' A%a+ila !dara %ada s!+!"an dan *edias"in!* san,a"  +an#a da%a" "er6adi o*%resi 6alan na%as dan 6an"!n, (&arolan< $010)'

6a!/ar 2.1 Pne!*!e)&a"t&n! a*+aran %ne!*o*edias"in!* %ada fo"o "horas

"a*%a se+a,ai daerah radiol!sens di sei"ar +a"as 6an"!n, iri' Medias"in!* +erh!+!n,an den,an daerah s!+*andi+!la< re"rofarin,eal< dan sel!+!n, %e*+!l!h darah leher< dan "oras la"eral (&arolan< $010)' E*fise*a s!+!"is "er6adi ai+a" !dara *e*as!i daerah=daerah "erse+!" dan +er*anifes"asi se+a,ai  %e*+en,aan "ida n#eri' Pada %al%asi aan "erasa se%er"i er"as' a*+aran radiolo,is !n"! e*fise*a s!+!"is adalah radiol!sen di "e%ian s"r!"!r ana"o*i "erai"'Ko*%liasi

18

ini da%a" *e*%er%arah eadaan %asien den,an %ne!*o"oras ai+a" o*%resi 6alan na%as' Per"olon,an %er"a*a #an, da%a" dila!an a%a+ila "er6adi di s"res adalah insisi !li" den,an %isa! %ada daerah !li" #an, *en,ala*i %e*+en,aan (Para*asia*< $00)'

BAB III

19

PENUTUP

3.1 Ke"&!(lan

.ari !raian se+el!*n#a da%a" disi*%!lan hal=hal se+a,ai +eri!": 1' Pne!*o"oras *er!%aan s!a"! ondisi di*ana "erda%a" !dara %ada a!* %le!ra ai+a" ro+en#a %le!ra iseralis a"a! ro+en#a dindin, dada dan %le!ra %arie"alis' $' Pne!*o"oras dilasifiasian +erdasaran *eanis*e e6adian #ani s%on"an dan  %ri*er< 6enis fis"el *en6adi si*%le dan "ension %ne!*o"oras< dan loalisasin#a' ' .ia,nosa %ne!*o"oras di"e,aan *elal!i ana*nesa dan %e*erisaan fisi< ser"a di"!n6an, oleh %e*erisaan radiolo,is' 4' Pena"alasanaan aal %ne!*o"oras dila!an +erdasaran %e*erisaan  Airay<  Breathing < dan Circulation sedan,an %ena"alasanaan lan6!"an se%er"i %e*asan,an chest tube< thoracotomy< dan %le!rodesis< dila!an +erdasaran 6enis %ne!*o"oras

dan %ere*+an,an eadaan linis %asien' 5' Ko*%liasi #an, da%a" +ere*+an, dari e6adian %ne!*o"oras an"ara lain e*fise*a s!+!"is dan %ne!*o*edias"in!* da%a" +erlan6!" *en6adi de%resi sal!ran na%as ,an,,!an on"rasi 6an"!n, dan +er!6!n, %ada e*a"ian'

DAFTAR PUSTAKA

Alsa,aff H< M!"# HA' $002'  7asar-7asar 6lmu Penyakit Paru' S!ra+a#a: Airlan,,a Uniersi"# Press'

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Arief

N<

S#ahr!ddin

E'

!i';o*C"esisC%ra"a*aA.'%df'

I00'

 Pneumotoraks'

/as;o*

R'

h""%:CC'%!l*o=

$009'

Pne!*o"oras'

h""%:CC'e*edi;ine';o*C*edCf!ll"o%i;C"o%i;155'h"* /as;o*< R' $011' Peumothora3' h""%:CCe*edi;ine'*eds;a%e';o*Car"i;leC4$4543'  Pneumothora3' /er;< M' $010' h""%:CCnefrolo,#ners'ord%ress';o*C$010C11C0C%ne!*o"hora@=$C'  Pneumotoraks" Tension and /ooan ' $009 h""%:CC'e*edi;ine';o*Ce*er,CTOP&430'HTM' /rohi K' $004' Chest Trauma8

Traumatic'

Pneumothora3-Simple '

h""%:CC'"ra!*a'or,Car;hieC"hora;i;C&HEST%ne!*o'h"*l' /rohi K' $004' Chest Trauma8 Pneumothora3-Tension' h""%:CC'"ra!*a'or,Car;hieC"hora;i;C&HEST"ension'h"*l' &arolan< P' $010'  Pneumomediastinum' Meds;a%e Referen;e'

E*edi;ine'

h""%:CC'*eds;a%e';o*Car"i;leC100402' &han, AK' $003'  Pneumothora3"  6atrogenic"

Spontaneous

and

Pneumomediastinum '

h""%:CC'e*edi;ine';o*Ce*er,CTOP&492'HTM' Heffner< E and H!,,ins< T' $004'  $anagement of Secondary Spontaneous  Pneumthora38 Thers9s Confusion in the Air. &hes" o!rnal> 1$5> 120=112$' Koro* S< &on#!r" H< Miss+a;h A< e" al' $011'  Pneumothora3.

h""%:CC'%a"ien"';o'!Cdo;"orCPne!*o"hora@'h"*' Ma;enDie< S< and ra#< A' $003'  Primary Spontaneous Pneumothora38 hy all the confusion over first-line treatment: ' o!rnal of Ro#al &olle,e of Ph#si;ians of 

Edin+!r,h> 3:5= M;&ool -.< Ro;hes"er

.-<

e"

al'

$00'

 Pneumothora3'

h""%:CC'harrisons%ra;"i;e';o*C%ra;"i;eC!+CieCHarrisons ?$0Pra;"i;eC141$3CallCPne!*o"hora@' Para*asia*< E' $00'  Air Leaks" Pneumothora3" and Chest 7rains8 Subcutaneous  ;mphysema" Pneumomediastinum" and Pneumopericardium' &on" ed! Anaes"h

&ri" &are J Pain' (9): $04=$02' O@ford Uniersi"# Press Sahn SA< Heffner E' Spontaneous Pneumothora3 ' N En,  Med $000> 4$: 9=34 l*aD< A< /a#ra*,Lrler< /< aD;ol!< O< ner< M< Er"!r!l< M< Ln,r< N< /aran< R' $00$'  6atrogenic Pneumothora38 6ncidence and ;valuation of the Therapy ' T!rish Res%ira"or# o!rnal< A!,!s" $00$< 8ol'< No'$

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