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At least 811 records · Page 45Linked to original sources
PubMed1988

Tracheobronchial rupture caused by blunt chest trauma: acute respiratory management.

The clinical management of 12 patients with major intrathoracic tracheobronchial rupture (complete, 3; incomplete, 9) due to blunt trauma has been reviewed and compared with that of two groups of patients with chest injuries not involving the tracheobronchial tree, 17 patients with multiple rib fractures and 17 with chest injuries requiring thoracotomy for control of pneumothorax and hemothorax. The effect of injury on ventilatory function was significantly greater in the patients with tracheobronchial injury in whom an elevated PCO2 at the time of admission was associated with a poor prognosis. Conventional ventilatory management with endotracheal intubation and positive pressure ventilation causing increased air leakage produced further deterioration of pulmonary function in four of the patients with tracheobronchial disruption. The use of a double-lumen endobronchial tube in two patients with tracheobronchial rupture facilitated ventilatory support and subsequent operative management.

Adolescent↗
PubMed1987

Chest-wall deformity following soft-tissue expansion for breast reconstruction.

We have presented a case in which the presumed pressure effects of tissue expansion caused multiple nondisplaced rib fractures of the anterior thorax in a patient undergoing breast reconstruction. Although the deformity was severe, a satisfactory cosmetic result was obtained and there have been no clinically significant sequelae during a 1-year follow-up period. The degree of bony deformation was most likely enhanced by the combination of this patient's severe osteoporosis, chronic steroid use, and peripheral vascular disease. The fragility and ease of fracture in the bones of osteoporotic postmenopausal females and the long-term effects of steroids on tissues is well known. We believe this observation to be important, since many reconstructed patients are postmenopausal and have variable degrees of osteoporosis. Many undergo adjuvant chemotherapy with steroids and antihormonal agents, and this group of women may therefore be at a greater risk for the occurrence of pressure deformities. The incidence and long-term significance of such deformities are not known. The reconstructive surgeon should be alert to the possibility of this phenomenon occurring as a result of tissue expansion in the patient with severe osteoporosis, peripheral vascular disease, or chronic steroid use.

Breast↗
PubMed1998

[A successful valve repair case of isolated tricuspid regurgitation due to traumatic lacerated papillary muscle of the tricuspid valve].

A case of tricuspid valve regurgitation due to a non-penetrating chest trauma was presented. This case involves a 20-year-old man, who was admitted to a nearby hospital because of rib fracture, mandibular fracture, and hemorrhage of the left hemopneumothorax, caused by a traffic accident. Palpitation and chest discomfort were observed at admission time, but there was no follow-up. Tricuspid regurgitation was pointed out during surgery for the mandibular fracture, and he continued follow up treatment at an outpatient clinic. However his palpitation and chest discomfort worsened, and he was admitted to our department 8 month after injury. During surgery to repair the tricuspid valve, a papillary muscle rupture, valve cusp laceration, and anulus dilatation were found. We performed a papillary muscle repair (chorda tendineae reconstruction), valve cusp suture, and annuloplasty. Absence of the left pericardium was observed during the operation. We reported valve repair of traumatic tricuspid regurgitation which with papillary muscle rupture. Due to its rarity and the fact that there has been no reported cases of papillary muscle repair for traumatic tricuspid regurgitation in Japan, we used researched information on the subject.

Adult↗
PubMed1983

Experiences in the management of chest injuries and a review of current management.

Eleven cases of chest trauma managed in the Intensive Care Unit (ICU), Alexandra Hospital were reviewed. Common manifestations were: rib fractures, haemothorax, pneumothorax, pulmonary contusion and flail chest. Nine patients had fractures on other sites of the body and three patients had associated abdominal injuries requiring laparotomy. Patients were referred to the ICU only when they were in respiratory distress. Transfer to the ICU occurred one to three days after admission to the hospital. Eight patients subsequently had to be ventilated. Two patients died. Respiratory failure in chest trauma is often the result of damage to the parenchyma, atelectasis and infection. Whilst the extent of parenchyma lung damage is dependent upon the severity of the injury and therefore not medically preventable, atelectasis and infection can be avoided. Patients with significant chest trauma should therefore be admitted directly to the Intensive Care Unit and the 'Expectant Therapy' instituted.

Critical Care↗
PubMed1983

[Pain relief with morphine, intrathecally or peridurally?].

We investigated pain relief following 1-2 mg morphine intrathecally applied in 7 patients with cancer pains and in 5 patients with multiple rib fractures (group 1). For postoperative pain relief (group 2) we applied 1-2 mg morphine intrathecally in 26 patients immediately before the induction of the anaesthesia. In 30 patients we applied 4 mg morphine epidurally in 10-20 ml saline solution for postoperative pain relief (group 3). In the first group the duration of the pain relief was 25,2 hours, in the second group 31 hours and in the third group 15,7 hours. In the second group a respiratory depression occurred in 3 cases and was successfully treated with naloxon. In the third group a bladder disorder occurred in two cases. Because of the risk of respiratory depression following intrathecally applied morphine, we recommend the epidural way of application.

Analgesia↗
PubMed1986

Problems caused by the unstable thoracic wall and by cardiac injury due to blunt injury.

The treatment of flail chest remains highly controversial. In the literature convincing arguments can be found to support any therapeutic procedure. Newer concepts of mechanical ventilation such as SIMV and CPAP, as well as the use of epidural analgesia, have resulted in a significant reduction in the duration of artificial ventilation. Although the mechanical problems are generally overestimated in this situation, the use of a ventilator is indicated in many cases because of the associated lung damage. Internal fixation of the unstable thoracic wall is restricted to special, selected cases which would otherwise require artificial ventilation, without severe lung injury and without head injury. We found stabilization of bilateral parasternal rib fractures with a retrosternal Sulamaa bar most helpful. Cardiac injuries were present in 16 per cent of our patients admitted after severe blunt thoracic injury. Most of these had myocardial contusion. The analysis of 108 cases of cardiac contusion revealed that every possible variation of ECG can be observed. Repolarization disturbances and impairment of the cardiac rhythm and the conduction system were found most frequently. A ratio of CPK-MB: total CPK of over 6 per cent provides a very significant suspicion of myocardial contusion. The clinical course is characterized by cardiac rhythm disturbances, which required treatment in 40 out of 108 patients, and to a minor extent by heart failure for which treatment was required in 17 patients. Prognosis is generally good with adequate treatment.

Analgesia↗
PubMed1991

[Chest injuries in children. Apropos of 93 cases].

UNLABELLED: Ninety-three cases of thoracic trauma (age ranging from 1.1/2 to 15 years) were observed over a 10 year-period (1980-1990): 86 cases of blunt trauma and 7 cases of perforating injuries. Road accidents were the most prevalent (63 cases) followed by home and sport injuries (9), falls (9), perforating trauma (9) and others. Associated lesions were frequent: skeletal (67), abdominal (19), and head injuries (5)--the latter influence the vital prognosis. Rib fractures were observed in 60% of cases of blunt trauma (86). Pulmonary lesions were as follows: pneumothorax (41), hemothorax (21), and lung contusions (29). In 48 cases, several of these pulmonary lesions were associated. Diagnosis and therapy problems were encountered in 21 cases. Results were as follows: 3 deaths, within 24 hours due to hemorrhage (1 case with aortic lesion). FOLLOW-UP: 85 good results, 5 sequelae, without any clinical consequence--either pleural (2), diaphragmatic (2), or lung (1). The treatment was as follows: none (27), pleural aspiration (2), thoraco-synthesis by drain in other cases for 2 to 9 days. Surgery was necessary in 10 cases, with 2 thoracotomies, 1 orthopedic traction, 1 embolization of iliac artery.

Abdominal Injuries↗
PubMed1987

Continuous epidural fentanyl analgesia: ventilatory function improvement with routine use in treatment of blunt chest injury.

The safety and effectiveness of continuous epidural fentanyl analgesia (CEFA) in the treatment of blunt chest injury was evaluated by reviewing its use in 40 patients with multiple rib fractures or flail chest. Ventilatory function tests were performed before and after the institution of CEFA and mean changes calculated. The use of CEFA was associated with significant improvement in vital capacity and maximum inspiratory pressure (p less than 0.05). Minute ventilatory volumes and tidal volumes also showed slight improvement. There was no significant change in arterial CO2 tension with the institution of CEFA, and 85% of patients had good pain relief with CEFA. None of these patients required any other narcotic administration. Documented complications associated with CEFA included pruritus, urinary retention, and transient hypotension. There were no major associated complications. The results suggest that CEFA is a safe, effective method of pain control that acts to improve ventilatory function in patients with blunt chest trauma.

Adult↗
PubMed1994

[Primary diagnosis and follow-up after thoracic trauma and lung contusion].

In 212 patients after injury of the thorax (54 males, 158 females; penetrating (15), blunt (197), multiple trauma (128)) 158 cases demonstrated rib fractures and 103 radiological proven pneumo- or hematothoraces or sometimes both, 108 of 138 had to be drained. 96.5% of the effusions and 98% of the pneumothoraces were clinical confirmed. 93.5% of 97 pulmonary contusions (79 unilateral, 18 bilateral) were detected by bronchoscopy within 10 h, 72% by x-ray. Caused by anatomical problems or for additional diagnosis 4 patients underwent thoracic CT. During ICU treatment 31 patients developed septic complications without detection in x-ray studies. In CT (n = 64) we found: 5 empyema, 13 pleural effusions, 4 pneumothoraces, 4 pneumocysts, 72 condensations of a lobe. After CT we performed: 9 resections of the lower lobe, 1 pneumectomy, 1 decortication, 7 thoracotomies with drainage, 8 drainages. To detect a septic focus under treatment the CT proved being an important diagnostic tool in chest trauma and lung contusion.

Adult↗
PubMed2000

[Ventilation in prone position in a 5-year-old child after multiple trauma. Effective treatment of persistent atelectasis].

We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgesic sedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artificial ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase in arterial oxygenation, which persisted in the following period. The hemodynamic situation remained stable. The complete disappearance of atelectasis was demonstrated radiologically after supine repositioning. After cessation of analgesic sedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.

Abdominal Injuries↗
PubMed2003

The Hybrid III dummy as a discriminator of injurious and non-injurious restraint loading.

This study evaluates the ability of the Hybrid III dummy and its associated injury criteria to discriminate sled tests with injurious conditions from those without. Ninety-three matched human cadaver and Hybrid III frontal sled tests over a range of impact speeds and restraint conditions are considered. Chest acceleration, deflection, and CTI are used as predictors of rib fracture outcome in the matched cadaver tests. Univariate and multivariate models are developed to evaluate the importance of the dummy measures relative to three experimental parameters (test speed, restraint condition, seating position) and three cadaver characteristics (age, gender, mass). The primary findings are, first, that chest acceleration has no utility for injury discrimination (Kruskal's Gamma = 0.0319, area under the receiver-operator characteristic = 0.500). Second, the functional relationship between any Hybrid III injury measure and injury risk is sensitive to all three experimental factors. Injury risk models with consideration of this dependence are presented. It is shown that the Hybrid-III chest deflection corresponding to a given level of injury risk is greatest for air bag loading, lowest for belt loading, and intermediate for combined loading. This is shown to be non-biofidelic, since chest deflection as measured directly on the cadaver does not exhibit this sensitivity.

Acceleration↗
PubMed2006

Predicting the need for early tracheostomy: a multifactorial analysis of 992 intubated trauma patients.

BACKGROUND: Tracheostomy has few, severe risks, while prolonged endotracheal intubation causes morbidity. The need for tracheostomy was assessed, based on early clinical parameters. METHODS: Adult trauma patients (January 1994-August 2004), intubated for resuscitation, ventilated >24 hours, were retrospectively evaluated for demographics, physiology, brain, and pulmonary injury. Tracheostomy patients were compared with those without. Chi-square, Mann-Whitney, and multivariate logistic regression were used with statistical significance at p < 0.05.* RESULTS: Of 992 patients, 430 (43%) underwent tracheostomy at 9.22 +/- 5.7 days. Risk factors were age (45.6* +/- 18.8 vs. 36.7 +/- 15.9, OR: 2.1 (18 years increments), ISS (30.3* +/- 12.5 vs. 22.0 +/- 10.3, OR: 2.1 (12u increments), damage control (DC) [68%*(n = 51) vs. 32%*(n = 51), OR: 3.8], craniotomy [70%*(n = 21) versus 30%(n = 9), OR: 2.6], and intracranial pressure monitor (ICP) [65.4%*(n = 87) vs. 34.6%(n = 46), OR: 2.1]. A 100% tracheostomy rate (n = 30, 3.0%) occurred with ISS (injury severity score) = 75, ISS >or=50, and age >or=55, admit/24 hour GCS (Glasgow Coma Scale) = 3 and age >or=70, AIS abdomen, chest or extremities >or=5 and age >or=60, bilateral pulmonary contusions (BPC) and >or=8 rib fractures, craniotomy and age >or=50, craniotomy with intracranial pressure (ICP) and age >or=40, or craniotomy and GCS or=90% (n = 105, 10.6%) was found with ISS >or=54, ISS >or=40, and age >or=40, admit/24 hour GCS = 3 and age >or=55, paralysis and age >or=40, BPC and age >or=55.A tracheostomy rate >or=80% (n = 248, 25.0%) occurred with ISS >or=38, age >or=80, admit/24 hour GCS = 3 and age >or=45, DC and age >or=50, BPC and age >or=50, aspiration and age >or=55, craniotomy with ICP, craniotomy with GCS or=90% risk undergo early tracheostomy and that it is considered in the >or=80% risk group to potentially decreased morbidity, increased patient comfort, and optimize resource utilization.

Adult↗
PubMedDate not supplied

Thoracic trauma: an analysis of 187 patients.

A retrospective analysis of 187 cases of thoracic trauma seen between January 1, 1994 and June 30, 1999 is presented. The majority of the patients were male (male-female ratio 2.9:1) and the average age at admission was 41.1 years. Blunt trauma, especially motor vehicle accidents (72.2%) and falls (17.1%), were the most frequent causes of chest injury (95.8%). We used the injury severity score (ISS) to assess the severity of trauma. The average ISS for the total group was 27.8 (ranges: 4-75). In only 17.6% of the patients an isolated thoracic trauma was present. Rib fractures (n = 133), pulmonary contusion (n = 110), pneumothorax (n = 78) and haemothorax (n = 65) were the most frequent lesions. Most patients (97.9%) were admitted to the intensive care department. A minority of the patients required thoracotomy (n = 19, 10.2%). Main indications for thoracotomy were pulmonary laceration (n = 5), aortic rupture (n = 3) and rupture of the diaphragm (n = 3). For the majority of cases, observation and/or tube thoracostomy (52.4%) and/or mechanical ventilation (61.0%) were sufficient. Pneumonia and adult respiratory distress syndrome were the most common complications (38.0 and 7.0% respectively). The overall mortality rate was 16.6%. Main causes of death were intracranial hypertension, sepsis combined with multiple organ failure, and hypovolaemic shock. For patients who did not survive the average ISS was 40.3. In a survival analysis the ISS was found to be the most significant determining survival (p < 0.0001), followed by neurotrauma (p = 0.05). Mortality after thoracic trauma remains relatively high, especially in case of associated neurotrauma. The ISS is a valuable score for assessing the severity of trauma and predicting outcome.

Accidental Falls↗
PubMed1997

Increased risk of stress fractures of the ribs in elite rowers.

In rowing, stress fractures are rare. However, the intensity of training has increased in terms of more specific rowing movements throughout the year. Simultaneously, new equipment has been developed resulting in faster rowing over the racing distance with increased risk of injuries on bones, muscles and ligaments. We report five cases of chest pain and one case of pain in the shoulder in national elite rowers, diagnosed as stress fractures of the ribs employing 99mTechnetium-MDP bone scan. In all cases, an increase or alteration in physical activity in the weeks prior to the injury and an increase in specific rowing movements with special emphasis on the new equipment, combined with increased biomechanical stress applied to the thoratic skeleton in the catch and the early part of the drive phase of the stroke, most probably caused the injuries.

Adult↗
PubMed2003

Occult head injury in high-risk abused children.

OBJECTIVE: Head injury is the leading cause of death in abused children under 2 years of age. Evidence for establishing guidelines regarding screening for occult head injury in a neurologically asymptomatic child with other evidence of abuse is lacking. This is particularly important given that many children with acute inflicted head injury have evidence of old injury when they are diagnosed. The primary aim of this study was to estimate the prevalence of occult head injury in a high-risk sample of abused children with normal neurologic examinations. The secondary aim was to describe characteristics of this population. METHODS: Children under 2 years of age admitted to an urban children's hospital between January 1998 and December 2001 with injuries suspicious for child abuse were eligible for this study if they had a normal neurologic examination on admission. Subjects were selected if they met 1 of the following "high-risk" criteria: rib fractures, multiple fractures, facial injury, or age <6 months. Subjects were excluded if they had a history of neurologic dysfunction, seizures, respiratory arrest, or if their initial physical examination revealed scalp injury. RESULTS: Of the 65 patients who met these criteria, 51 (78.5%) had a head computed tomography or magnetic resonance imaging in addition to skeletal survey. Of these 51 patients, 19 (37.3%, 95% confidence interval 24.2-50.4%) had an occult head injury. Injuries included scalp swelling (74%), skull fracture (74%), and intracranial injury (53%). All except 3 of the head-injured patients had at least a skull fracture or intracranial injury. Skeletal survey alone missed 26% (5/19) of the cases. Head-injured children were younger than non-head-injured children (median age 2.5 vs 5.1 months); all but 1 head-injured child was <1 year of age. Among the head-injured children, 72% came from single parent households, 37% had mothers whose age was <21 years, and 26% had a history of prior child welfare involvement in their families. Ophthalmologic examination was performed in 14 of the 19 cases; no retinal hemorrhages were noted. CONCLUSIONS: Our results support a recommendation for universal screening in neurologically asymptomatic abused children with any of the high-risk criteria used in this study, particularly if that child is under 1 year of age. Ophthalmologic examination is a poor screening method for occult head injury, and one should proceed directly to computed tomography or magnetic resonance imaging. Given the high prevalence of occult head injury detected in this study, further study is warranted to estimate the prevalence of occult head injury in lower risk populations of abused children.

Adult↗