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PubMed2006

[Penetrating thoracic injury].

PURPOSE: To clarify the clinical aspects of penetrating thoracic injury. PATIENTS AND METHODS: Eighteen patients with penetrating thoracic injury treated from 1987 to 2005 were evaluated. There were 13 men and 5 women. The age distribution was 8 to 69 years, with an average of 36.7 years. RESULTS: There were 14 patients with stab wound and 4 with impalement injury. Five patients with stab wound were those who attempted suicide. In 4 patients with impalement injuries, the cause was fall in 2, traffic accident in 1 and sports injury in 1. The calculated injury severity score (ISS) was over 15 in 4 patients, 6 to 14 in 12, and under 5 in 2. Thoracotomy was performed in 2 patients with cardiac tamponade, 3 with massive hemothorax and 1 with an impalement injury caused by an iron bar. All of them were rescued and got well. In the other cases, after cleansing and debridement, the wound was closed and thoracic drainage was performed. Only 1 patient with cardiac arrest on arrival died within 24 hours after reviving. CONCLUSIONS: Emergent thoracotomy is indicated for patients with massive bleeding including shock, continuous air leakage and cardiac tamponade. Since cardiac arrest is difficult to cure, appropriate cooperation with the rescue team is necessary to avoid preventable trauma death.

Adolescent↗
PubMed1978

[Rare thoracic injuries (biomechanics, diagnosis and therapy) (author's transl)].

Thoracic injuries caused by direct or indirect power action involve various injury effects. The extent of injury depends on the force and the direction of the acting power, on the biomechanical properties of the partial structures of the thorax, and on genetically determined variations of form and structure. These correlations are demonstrated by special examples of rare thoracic injuries. The motto for the diagnostic and the choice of the therapeutical procedure is: "Inter vulnerationem thoracis diagnosis incipiat".

Accidents, Traffic↗
PubMed2005

[Thoracic injuries associated with acute traumatic paraplegia of the upper and middle thoracic spine].

AIM: The aim of this study was to analyse the number of thoracic injuries associated with acute traumatic paraplegia of the upper and middle thoracic spine and review the early management in respect to treatment standards. METHODS: Using a prospective study protocol, data were sampled and analyzed from 12 December 2000 to 31 March 2002 at a level 1 trauma center. RESULTS: Twenty-two consecutive patients were included in the study. Sixteen suffered severe chest traumata. Lung contusion was diagnosed in 81%, followed by haemopneumothorax (75%) and fracture of the bony chest (75%). Intubation was performed 12 times in all. Chest drainage was performed in 14 patients. The mean duration of artificial ventilation was 20 days (range 2-93) and of intensive care treatment 25 days (range 2-93). Five patients died. CONCLUSIONS: Acute traumatic paraplegia of the upper and middle thoracic spine caused by high energy trauma is highly associated with severe chest trauma. Therefore, respiratory impairment must be kept in mind during the early treatment. If respiratory failure becomes more evident, emergency procedures such as intubation and chest drainage have to be performed. Secondary transfer should be avoided.

Accidental Falls↗
PubMed2004

The influence of side airbags on the risk of head and thoracic injury after motor vehicle collisions.

BACKGROUND: Side airbags (SABs) were developed as an energy-absorbing barrier to protect specific occupant body regions in near side impact motor vehicle collisions. METHODS: The National Automotive Sampling System Crashworthiness Data System was used to evaluate drivers and front-seated passengers in 1998 or newer vehicles involved in near side impact collisions. Risk ratios were calculated comparing the risk of head and thoracic injury among occupants in vehicles with and without SABs adjusting for occupant, vehicle, and collision characteristics. RESULTS: Occupants in vehicles equipped with head protection SABs had a 75% lower risk of head injury (p = 0.008) after near side collisions. With respect to thoracic injury, SABs that provide thoracic protection are associated with a 68% reduction (p = 0.01) in thoracic injury risk. CONCLUSION: As SAB-equipped vehicles become an increasingly larger segment of the on-road vehicle fleet, the impact of head and thoracic injury after near side impact collision is likely to be reduced.

Accidents, Traffic↗
PubMed1989

Sharp thoracic injury.

In an effort to develop effective rules for the management of penetrating thoracic injuries, all records of 515 patients treated for sharp chest injuries between 1961 and 1985 at the University Hospitals of Amsterdam (Binnengasthuis, Wilhelmina Gasthuis and Academic Medical Centre), were reviewed. The analysis reveals that of these patients 321 (62 per cent) could be treated conservatively, because of a non-penetrating injury, while 140 had a penetrating injury, of whom 77 had to be operated on. Eleven patients died (2.1 per cent). Data concerning these patients are discussed separately. Based on our analysis, and supported by recent literature, an aggressive approach towards penetrating thoracic injury in haemodynamically unstable patients is justified.

Adolescent↗
PubMed2001

Thoracic injuries in children.

The successful management of pediatric thoracic injuries includes immediate and careful evaluation of the injury type and severity. Early treatment can be conservative in nature or require surgical management. Prompt intervention can reduce morbidity and mortality rates, associated complications, and ensure optimal outcomes.

Accidental Falls↗
PubMed1990

[Thoracic injuries in traffic accidents and non-traffic accidents].

Traffic accidents differ from non-traffic accidents where the injuries are concerned. With the males two thirds of the thoracic injuries happened in non-traffic accidents and one third in road accidents; with the females, the relation was reversed. In thirteen per cent of the traffic accidents and in twenty-five per cent of the non-traffic accidents there were only thoracic injuries, in the other cases there were multiple injuries. Blunt damages of the thorax occurred in the majority of both kinds of accidents, penetrating injuries were less common. Closed rib fractures happened twice as often in traffic accidents as in accidents at work. Compound fractures of the ribs were three times as frequent in non-traffic accidents as in traffic accidents. In thirty-five per cent of road accidents and in twenty-two per cent of non-traffic accidents the injuries were of an intrathoracal kind. Of all the three hundred and thirty thorax injured patients thirty-four did not survive their injuries, twenty-nine due to traffic accidents, and five due to non-traffic accidents.

Accidents, Occupational↗
PubMed1994

[Penetrating thoracic injuries--a 10 year analysis of 179 patients].

179 patients with penetrating chest wall and thoracic injuries were treated at the University Hospital "Rudolf Virchow" in Berlin between 1982 and 1992. Most patients (72.4%) were successfully treated with closed tube thoracostomy alone. 33 (18.4%) patients required thoracotomy, 14 (7.8%) due to injury of the great vessels and 15 (8.3%) due to cardiac injuries. In 10 (5.5%) patients also abdominal organs were compromised, so that also a laparotomy had to be done. Seven (3.9%) patients died. All but one patients who died, died in the OR or within 24 h of admission. So lethality in the group of cardiac wounds was 44.6% (7 out of 15). This underlines the necessity of most rapid transport to the hospital in case of thoracic injury.

Adolescent↗
PubMed2004

A Theoretical Math Model for Projecting AIS3+ Thoracic Injury for Belted Occupants in Frontal Impact.

A theoretical math model was created to assess the net effect of aging populations versus evolving system designs from the standpoint of thoracic injury potential. The model was used to project the next twenty-five years of thoracic injuries in Canada. The choice of Canada was topical because rulemaking for CMVSS 208 has been proposed recently. The study was limited to properly-belted, front-outboard, adult occupants in 11-1 o'clock frontal crashes. Moreover, only AIS3+ thoracic injury potential was considered. The research consisted of four steps. First, sub-models were developed and integrated. The sub-models were made for numerous real-world effects including population growth, crash involvement, fleet penetration of various systems (via system introduction, vehicle production, and vehicle attrition), and attendant injury risk estimation. Second, existing NASS data were used to estimate the number of AIS3+ chest-injured drivers in Canada in 2001. This served as data for model validation. Third, the projection model was correlated favorably with the 2001 field estimate. Finally, for the scenario that 2004-2030 model-year systems would perform like 2000-2003 model-year systems, a projection was made to estimate the long-term effect of eliminating designs that would not comply with the proposed CMVSS 208. The 2006-2030-projection result for this scenario: 764 occupants would benefit from the proposed regulation. This projection was considered to be conservative because future innovation was not considered, and, to date, the fleet's average chest deflections have been decreasing. The model also predicted that, through 2016, the effect of improving system performance would be more influential than the population-aging effect; thereafter, the population-aging effect would somewhat counteract the effect of improving system performance. This theoretical math model can provide insights for both designers and rule makers.

Journal Article↗
PubMed1990

[The treatment of thoracic injuries from the anesthesiologic viewpoint].

Three quarters of thoracic injuries are combined with other traumas, firstly head injuries, secondly injuries of the extremities and thirdly injuries of the abdomen. Seventy-one such patients who were treated in the interdisciplinary intensive care department over 6 years were analysed. In 13 patients laparotomies because of ruptures or perforations of various organs became necessary. These combined injuries had a particularly bad prognosis. Forty-six patients (64.7%) had to be ventilated for more than 24 hours. The average ventilation period was 10 days. The indication for respiratory treatment is stressed. The lethality of the 71 patients amounted to 32.4% (23 patients). During the first treatment even today simple methods of investigation and therapy are of great importance. A comprehensive rescue chain and good interdisciplinary cooperation are the basis of every therapy.

Adolescent↗
PubMed2000

Management of simple thoracic injuries at a level I trauma centre: can primary health care system take over?

BACKGROUND: Overtriage is a problem for all trauma systems, including the Greek emergency system. In this study we examined the performance of the primary care emergency system in the treatment of patients with simple thoracic injuries, in the area of a Level I hospital. Our aim was to form organizational proposals and treatment and referral guidelines in an effort to improve the system's performance. METHODS: We reviewed the notes of 488 patients with a thoracic injury as their main complaint, seen and immediately discharged from the A+E department of a Level I hospital. RESULTS: Falls and road traffic accidents were the most common mechanisms of injury. The majority of the injuries were rib fractures or rib cage contusions. Many patients sought medical advice several days after the injury. Fifteen patients required conservative treatment for orthopaedic injuries. Clinical examination, X-rays and abdominal ultrasound were the most useful tests. CONCLUSIONS: Detailed clinical examination, time from injury and a chest X-ray usually identifies the patients who can safely be treated in primary health care facilities. Simple radiology services (X-ray and US) and training of general practitioners in basic emergency care principals in primary care health centres would reduce the number of referred patients with simple thoracic injuries.

Accidental Falls↗
PubMed2004

Thoracic packing for uncontrolled bleeding in penetrating thoracic injuries.

We present a series of three patients who suffered penetrating thoracic injury, and in whom thoracic packing was used as a life-saving procedure. Survival among these patients paralleled the severity and extent of the original injuries. Restriction of cardiac filling and lung expansion are potential deterrents from using this technique; however, its use seems to be a valid adjunct, especially in the setting of chest wall bleeding coming from the intercostal arteries. Damage control surgery in pentrating thoracic trauma, including thoracic packing, is a sound alternative when uncontrollable bleeding, hypothermia and coagulopathy compromises the survival of a patient.

Adolescent↗
PubMed1983

[Pathophysiology of thoracic injuries].

A systematic review of the pathophysiology of thoracic injuries has not yet been published. As an introduction all kinds of injuries of the chest are listed. The causes of the so called "acute thorax" are described. Furthermore three cardinal symptoms which occur after thoracic trauma are distinguished and explained: hemorrhagic shock, the combination of venous congestion and low cardiac output (which is very similar to cardiogenic shock) and hypoxia. A short description of the pathophysiology of the acute respiratory distress syndrome (ARDS) is given. The review ends with some remarks to the therapeutic management of chest injury and to the aftereffects of initial therapy.

Acute Disease↗
PubMed1976

The management of acute thoracic injuries.

The injuries resulting from blunt and penetrating injuries to the thoracic cage and its contents require prompt recognition and treatment. An outline of the major problems and recommendations for management is presented.

Critical Care↗
PubMed1986

[Chylothorax from closed thoracic injuries. Apropos of a case. Review of the literature].

Chylothorax of traumatic origin represents 60% of cases reported. A patient presented with a chylothorax from a closed chest injury, these representing only 10% of total cases seen with injury to the thoracic duct. Direct lesions, of either accidental or perioperative origin are the most frequent lesions. Various elements relating to the circumstances of onset, diagnostic factors and different therapeutic procedures are discussed. The course of these lesions after treatment is usually very favorable, as a result of the essential close cooperation between surgeons and intensive care physicians.

Chylothorax↗