1. SKILL LABORATORY RESPIRATORY SYSTEM YANA AKHMAD ARTO YUWONO PRAYUDI SANTOSO

2. TOPIC NEEDLE THORACOSTOMY HEIMLICH’ MANEUVER OBJECTIVE BE ABLE TO PERFORM PROCEDURE OF NEEDLE THORACOSTOMY AND HEIMLICH’ MANEUVER KNOW INDICATIONS AND GOAL OF THE PROCEDURES

3. INTRODUCTION NEEDLE THORACOSTOMY PROCEDURE FOR EMERGENCY DECOMPRESSION OF THE CHEST UNTIL A CHEST TUBE CAN BE INSERTED PATIENT WITH LIFE THREATENING TENSION PNEUMOTHORAX

4. PNEUMOTHORAX THE PRESENCE OF AIR WITHIN PLEURAL SPACE CATAGORIES : TRAUMATIC (ACCIDENTAL OR IATROGENIC) SPONTANEOUS (WITHOUT AN OBVIOUS CAUSE) - PRIMARY (NO UNDERLYING LUNG DISEASE) - SECONDARY (HAS A PREDISPOSING LUNG DISEASE)

5. MECHANISM COMMUNICATION BETWEEN THE ALVEOLI AND THE PLEURAL SPACE (BRONCHOPLEURAL FISTULA) COMMUNICATION BETWEEN THE ATMOSPHERE AND THE PLEURAL SPACE (PENETRATING CHEST WOUND OR TRAUMATIC)

6. CLINICAL MANIFESTATION DEPEND ON THE VOLUME OF THE PNEUMOTHORAX AND PRESENCE OR ABSENCE OF UNDERLYING LUNG DISEASE SYMPTOM - DYSPNEA - CHEST PAIN : SHARP AND ABRUPT SMALL PNEUMOTHORAX : - ASYMPTOMATIC

7. TENSION PNEUMOTHORAX OCCUR WHEN AIR IN THE PLEURAL SPACE EXCEEDS ATMOSPHERIC PRESSURE MEDIASTINAL SHIFT TO CONTRALATERAL SIDE, PLACES TORSION ON THE INFERIOR VENA CAVA, VENOUS RETURN DECREASE, CARDIAC OUTPUT DECREASE, AND HIPOTENSION RESULT THE LUNG CONTINOUS TO COMPRESS, INTRA PULMONARY SHUNTING THROUGH THE COLLAPSED LUNG CAUSED HYPOXEMIA LIFE THREATENING TREATMENT IS EMERGENCY DECOMPRESI OF THE CHEST NEEDLE THORACOSTOMY

10. Learning Guide for needle thoracostomy A. Preparation the tools : needle no.16, syringe 3cc, gloves, cotton swab, povidon iodine, normal salin, com, kidney basin, measuring glass with water tube, tape. B. CLIENT ASSESSMENT 1. Greet client respectfully and with kindness 2. The patient should be given adequate explanation about needle thoracostomy and the goal or expected result of needle thoracostomy (Briefly)

12. C. PERFORMING NEEDLE THORACOSTOMY 1. Wash your hand and dry it with dry towel. Put on the gloves. 2. Clean the skin around the second intercostals space at the midclavicular line, using povidone –iodine solution. Use a circular motion, starting at the center and working outward. 3. Fill the syringe with 2 cc sterile normal saline

13. 4.Insert a sterile 16G or larger needle with attached syringe immediately over the superior portion of the rib and through the tissue covering the pleural cavity while aspirating 5.When air is aspirated, advance catheter completely, and withdraw syringe. Withdraw syringe following connect the inserted needle with tubing immediately and place the other end of tubing in a measuring glass filled with water 6. Leave the needle in place until a chest tube can be inserted.

16. INTRODUCTION FOREIGN BODY AIRWAY OBSTRUCTION - VOMITUS, FOOD BOLUS, OTHER MAY CAUSE EITHER PARTIAL OR COMPLETE OBSTRUCTION PARTIAL OBTRUCTION : CONSCIOUS AND COUGHING

17. COMPLETE OBSTRUCTION : CANNOT TALK, COUGH OR BREATH  THE PATIENT CLUTCHES AT HIS/HER THROAT (UNIVERSAL DISTRESS SIGNAL OF FOREIGN BODY OBSTRUCTION)  NEED OF EMERGENCY INTERVENTION  THE PROCEDURE OF CHOICE FOR CLEARING A FOREIGN BODY FROM AIRWAY OBSTRUCTION : - ABDOMINAL THRUSTS (HEIMLICH’MANEUVER) ADULT, CHILDREN - BACK BLOWS - CHEST THRUSTS INFANT, ADVANCED PREGNANCY

18. HEIMLICH’ MANEUVER THE PROCEDURE OF CHOICE FOR CLEARING A FOREIGN BODY FROM AIRWAY OBSTRUCTION : THIS PROCEDUR NORMALY ARE FOLLOWED BY A MANUAL CHECK AND REMOVAL OF ANY OBSTRUCTING FOREIGN MATERIAL

19. FORCEFUL THRUSTS APPLIED TO THE EPIGASTRIUM CAN DISLODGE AN OBSTRUCTION CAUSED BY FOREIGN BODY QUICK THRUSTS TO THE ABDOMEN DISPLACE DIAPHRAGM UPWARD INCREASING INTRATHORACIC PRESSURE AND CREATING EXPLUSIVE EXPIRATORY AIRFLOW EXPEL THE FOREIGN BODY FROM THE AIRWAY

20. Learning Guide for Heimlich Manuver No.STEPS/TASK A. CLIENT ASSESSMENT 1.Greet client respectfully and with kindness 2The patient should be given adequate explanation about Heimlich manuver and the goal or expected result Heimlich maneuver (Briefly) B. PERFORMING ABDOMINAL THRUSTS (HEIMLICH ’ MANUVER) 1.Standing behind the patient, wrap both arms around his waist. 2.Place your fist int the center of his abdomen, midway between the umbilicus and the xiphoid process. Rest the thumb side of your fist aginst his epigastrium and then grasp your fist with your other hand. 3.Using a quick motion, thrust your fists inward and upward 4.Repeat the process until the obstruction is removed