Are we meeting current recommendations for the initial management of penetrating trauma? A preliminary analysis from a Colombian institutional registry (original) (raw)
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Management of Thoracic Traumas: Analysis of 28 Patients
The International Annals of Medicine
Objectives: Trauma is the most common cause of death. Two parts 3 of all traumas are connected to the chest and the mortality is second after head injury. The purpose of this study is to determine the diagnosis, survival and treatment methods of chest traumas in a single-center. Methods: Between 01.08.2017 and 01.02.2018, all patients with thorax trauma admitted to the emergency service of our hospital and needed hospitalization were retrospectively reviewed with age, gender, additional systematic injuries, diagnosis, type of treatment, duration of hospitality. Results:17 male and 11 female patients were evaluated with ages ranging from 8 to 84 years (mean 39.6). There were 26 blunt and 2 penetrating injuries. Etiological factors were fall in 5(17%), motor vehicle accidents in 19, assault in 2, stab wound in 1and gunshot in 1 case. 10 patients had pneumothorax, 5 hemothorax, 19 rib fracture, 22 pulmonary contusion, 2 sternum fractures determined. 25 patients followed up conservatively, chest tube insertion applied in 2 patients and 1 patient underwent operation because of lung laceration. There were no mortality. Conclusions: Thoracic traumas are life threatening injuries and should be treated immediately. Identification and severe of injury is the guide of the treatment modality.
European Journal of Trauma and Emergency Surgery, 2012
Background An emergency department thoracotomy (EDT) or an emergency thoracotomy (ET) in the operating theater are both beneficial in selected patients following thoracic penetrating injuries. Since outcome-descriptive European studies are lacking, the aim of this retrospective study was to evaluate ten years of experience at a Dutch level I trauma center. Method Data on patients who underwent an immediate thoracotomy after sustaining a penetrating thoracic injury between October 2000 and January 2011 were collected from the trauma registry and hospital files. Descriptive and univariate analyses were performed. Results Among 56 patients, 12 underwent an EDT and 44 an ET. Forty-six patients sustained one or multiple stab wounds, versus ten with one or multiple gunshot wounds. Patients who had undergone an EDT had a lower GCS (p \ 0.001), lower pre-hospital RTS and hospital triage RTS (p \ 0.001 and p = 0.009, respectively), and a lower SBP (p = 0.038). A witnessed loss of signs of life generally occurred in EDT patients and was accompanied by 100 % mortality. Survival following EDT was 25 %, which was significantly lower than in the ET group (75 %; p = 0.002). Survivors had lower ISS (p = 0.011), lower rates of pre-hospital (p = 0.031) and hospital (p = 0.003) hemodynamic instability, and a lower prevalence of concomitant abdominal injury (p = 0.002). Conclusion The overall survival rate in our study was 64 %. The outcome of immediate thoracotomy performed in this level I trauma center was similar to those obtained in high-incidence regions like the US and South Africa. This suggests that trauma units where immediate thoracotomies are not part of the daily routine can achieve similar results, if properly trained.
Our Experience in the Treatment of Severe Thoracic Trauma
Albanian Journal of Trauma and Emergency Surgery
Background: Severe thoracic trauma is main cause of deaths in US about 10-20 % of deaths. Causes of severe thoracic Trauma are :Penetrating trauma,Gunshot wounds,Stab wounds ;Lower mortality rate less massive, less multiorgan injury Gunshot wounds on the chest is the most lethal – 50% .Only 7-10% undergoes hospitalization prior to death .Death due to heart & great vessel injuries. Aim of study: Analyses of patients with Severe Thoracic Trauma ,Initial Evaluation and Management analyses of our cases period of time 2004-2017 treated in thoracic surgery service Material and methods: 95 patients are treated in our hospital during July 2004- July 2017 timeframe. Male to female was ratio 3:1. Age of presentation 9-71 years old, mean age presentation 49 years old. Blunt chest wall trauma 36 (38%) and penetraiting chest wall trauma 59 (62%) patients. Ribs and sternal fractures , two or more costal fractures in 15 (15.7%) patients (flail chest 7 patients );unilateral pneumothora...
Thoracic trauma: presentation and management outcome. J Coll Physicians Surg Pak. 2008 Apr;18(4):230-3. doi: 04.2008/JCPSP.230233. [PubMed] PMID:18474157, 2008
Objective: To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. Study Design: Case series study.Place and Duration of Study: The study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January to December 2005.Patients and Methods: A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages.Results: Out of 143 patients, 119 (83%) were males and 24 (17%) were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66%) patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45 %) patients. Seventeen (11.88 %) patients were managed with mechanical ventilation. There were 17 deaths with a mortality rate of 11.88%. Conclusion: Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions.
European Journal of Trauma and Emergency Surgery, 2017
part, kept short and concise, with a short list of important messages to take home at the end of each chapter, and a list of recommended reading. Section I deals with Prehospital care, Diagnostic tools and Resuscitation Strategies, and starts with a well-balanced discussion of the several controversies on the subject. Many of the first chapters are devoted to this neverending controversy of BLS vs. ALS in urban vs rural environments, and some concepts are excessively repeated throughout this section. The chapters on Airway Management, Resuscitation, ABC Heuristics, Intensive Care, VAT Surgery, and Ballistics, are to be highlighted. Section II deals with Surgical Strategies in Penetrating Trauma to the Head, Face and Neck. The chapter on penetrating injuries to the Face, an area not particularly familiar to the average general or trauma surgeon, is worth of mention, as are the chapters on injuries to the Pharynx and Cervical Esophagus, and to Blood Vessels. The vast experience of general and trauma surgeons trained and/or working in South Africa, as said, is clearly shown in this latter chapter. Again, the number of chapters devoted to similar topics makes for some repeated statements, specifically regarding the surgical anatomy of the neck, and maneuvers to control bleeding. Section III deals with Surgical Strategies in Penetrating trauma to the Chest. Of particular interest is the chapter on trauma to the Subclavian Vessels, which provides a very detailed anatomic description of the different steps to deal with these difficult, although infrequent injuries, and the chapter on trauma to the thoracic esophagus. This latter chapter also provides some very useful tips for the management of this infrequent trauma injury, which can also be applied to non-trauma esophageal perforations and damage. The chapter on Cardiac trauma nicely reflects the extensive practical experience of its authors.
Canadian journal of surgery. Journal canadien de chirurgie
The frequency of penetrating trauma is low in Canada. Current recommendations for the care of patients with penetrating injuries originate from inner city trauma centres with a high volume of such injuries and may not apply to Canada. The purpose of this study was to review the incidence and treatment of penetrating thoracoabdominal injuries in the 4 tertiary trauma centres in Quebec. We identified all patients with penetrating thoracic or abdominal injuries who were taken to any of the 4 tertiary trauma centres in the province of Quebec between Apr. 1, 1998, and Mar. 31, 2001. Patients who were dead on arrival were excluded. Only patients with an Abbreviated Injury Scale of 2 or greater for the thoracic or abdominal regions were included. In total, 245 patients meeting our inclusion criteria were identified. Of these 223 (91%) were male. The mean (and standard deviation) age was 33.8 (13.2) years; range 15-90 years. The median Injury Severity Score was 10 (range 4-75). Overall in-h...
European Archives of Medical Research, 2019
Anesthesia Management in Trauma Trauma, which means wound in ancient Greek, is the leading cause of death in the 1-44 age group, and the third cause of death following cancer and cardiovascular disease in all age groups. Trauma is defined as tissue damage characterized by structural changes and physiological disorders due to mechanical, thermal, electrical and chemical energies, ionized or nuclear radiation or absence of essential elements of life such as oxygen and heat. Trauma has many reasons such as traffic accidents, work accidents and falling from height (1,2). These patients need a systematic anesthesia management in posttraumatic evaluation, airway management, resuscitation, possible preoperative and postoperative surgical process, intensive care follow-up and treatment (3). The nature of trauma, uncontrollable bleeding after trauma, coagulation anomalies, hypothermia, shock, acidosis disrupt the normal homeostatic mechanism. Acute coagulopathy caused by high blood loss in major traumas is often associated with poor clinical course in trauma patients (4,5). Another paradox is the nature of unexplained events, insufficient anamnesis information and the necessity of emergency intervention in trauma cases. Initial Assessment of Trauma Algorithms have been defined for systemic approach to trauma patients and more than fifty scoring systems have been developed. The Trauma score, which was defined in 1981 by adding respiratory rate and systolic blood pressure to the Triage index, is a widely used scoring system. It was revised in 1989 and Revised Trauma score was formed (Table 1). In order for the trauma centers to systematically engage a modern trauma approach in harmony between the other disciplines, it is necessary to establish national guidelines tailored to the needs and ensure their widespread use. Airway obstruction, severe hemorrhage and hypoxia due to tension pneumothorax may be among the causes of early death due to trauma (6-8). From the moment the trauma patient is met, the first step is to apply the
Factors affecting mortality in cardiac injury of penetrating thorax trauma: a retrospective study
Gaziantep Medical Journal, 2014
ABSTRACT In this study, we investigated the factors affecting survival in patients who were operated for penetrating cardiac and vascular injuries due to penetrating thoracic trauma. Ninety-six patients with penetrating thoracic trauma (90 males, 6 females, mean age 26±8 years) who were admitted to our clinic between January 2010 and January 2013 were recruited to the study. Retrospective evaluation of the cause of trauma, age, gender, concomitant organ injuries, Rohman classification, Glasgow coma score, Heart Injury Scale, Lung Injury Scale, penetrating thoracic trauma index, surgical intervention, and mortality were determined. The mortality rate was 39.6% in our study and correlated with cardiac tamponade, systolic blood pressure, heart rate, Glasgow coma score, heart injury scale and penetrating thoracic trauma index. However, a significant relationship was found only between mortality and systolic blood pressure in a binary logistic regression model (p=0.024). In patients with penetrating thoracic trauma, rapid assessment and management of fluid and blood resuscitation that can hold the systolic blood pressure above 80 mmHg and prompt surgical intervention may reduce mortality and may affect the outcomes in penetrating cardiac and other major vascular injuries. Özet Bu çalışmada, sadece penetran toraks travması olan, kardiyak ve büyük damar hasarlanması nedeni ile ameliyat edilen hastalarda sağ kalıma etki eden faktörler incelenmiştir. Ocak 2010-Ocak 2013 yılları arasında acil servise penetran toraks travması nedeni ile başvuran 632 hasta dosyası retrospektif olarak incelenmiş ve 96 hasta (90 erkek ve 6 kadın, ortalama yaş 26±8 yıl) çalışmaya alınmıştır. Hastaların yaşı, cinsiyeti, yaralanma şekli, eşlik eden diğer yaralanmaları, Rohman sınıflaması, Glasgow koma skorlaması (GKS), kalp hasar skalası, akciğer hasar skalası, penetran toraks travma sınıflaması, uygulanan cerrahi girişim ve mortaliteleri incelenmiştir. Çalışmadaki mortalite oranı %39.6 olarak bulunmuştur. Mortalite; kardiyak tamponad, sistolik arter basıncı, kalp hızı, Glasgow koma skoru, kalp hasar skalası ve penetran toraks travma sınıflaması ile korole bulunurken ikili lojistik regresyon modellemesinde sadece sistolik arter basıncının 80 mmHg altında oluşu mortalite ile ilişkili bulunmuştur (p=0.024). Penetran toraks travması bulunan hastalarda hızlı klinik değerlendirme sonrasında sistolik arter basıncını 80 mmHg üstünde tutacak şekilde sıvı resüsitasyonu ve kan replasmanı yapılması ve hızlı cerrahi müdahale mortaliteyi düşürebilir ve penetran kalp ve damar yaralanması olan hastaların sağ kalımına olumlu etki edebilir. Anahtar kelimeler: Kardiyak yaralanma; penetran kalp yaralanması; penetran göğüs travması Introduction Patients with penetrating thoracic trauma that require surgical intervention because of invasive pulmonary damage, major vascular injuries in the thoracic area and crucial cardiac injuries have the highest mortality rates (1). Clinical presentation of the patient depends on various factors such as the wounding mechanism; the time elapsed prior to arrival at the hospital, the extent of the injury, the amount of blood loss, the presence of cardiac