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At least 19 recordsLinked to original sources
PubMed1995

Thoracic injuries.

Thoracic injury is the second leading cause of death in pediatric trauma, second only to head injury in lethal potential. With the exception of lung contusion, serious injuries to vital thoracic structures are associated with mortality rates in excess of 50%. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Facility with management of thoracic injuries is therefore vital to optimal outcome in childhood trauma.

Cause of Death↗
PubMed2000

Driver and right-front passenger restraint system interaction, injury potential, and thoracic injury prediction.

Restrained driver and right-front passenger kinematics and injury outcome in frontal collisions are compared using FARS data and human cadaver sled tests. The FARS data indicate that a frontal airbag may provide greater benefit for a passenger than for a driver. The thoracic injuries sustained by passenger subjects restrained by a force-limited, pretensioned belt and airbag are evaluated, and kinematics are compared to driver-side subjects. The injury-predictive ability of existing thoracic injury criteria is evaluated for passenger-side occupants. Driver and passenger kinematic differences are identified and the implications are discussed. The chest acceleration of the passenger-side subjects exhibited a bimodal profile with an initial (and global) maximum before the subject loaded the airbag. A second acceleration peak occurred as the subject loaded both the belt and the airbag. A similarly restrained driver-side subject loaded the belt and airbag concurrently at the time of peak chest acceleration and therefore did not exhibit this bimodal chest acceleration.

Acceleration↗
PubMed2004

Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries.

OBJECTIVE: Thoracic injuries are among the most severe forms of trauma and also a leading cause of morbidity and mortality. Video Assisted Thoracic Surgery (VATS) has recently provided an alternative method to simultaneously diagnose and manage patients sustaining chest injuries. We analyze our experience with VATS in the setting of thoracic trauma detailing indications for exploration, procedures performed and results of surgery. METHODS: A 6-year single institution review of patients undergoing VATS due to injuries sustained from both blunt and penetrating chest trauma at a Level I trauma center and university teaching hospital. Comparisons were made between groups of blunt and penetrating trauma as to Injury Severity Score (ISS), presence of extra-thoracic injuries, initial thoracostomy drainage and length of postoperative stay. RESULTS: VATS was successfully performed in 19 consecutive patients without conversion to thoracotomy. Indications for exploration included acute hemorrhage, retained hemothorax, suspected diaphragmatic injuries (DI), suspected cardiac injury, intra-thoracic foreign body, persistent airleak and chronic empyema. Procedures performed consisted of evacuation of retained hemothorax, hemostasis of intra-thoracic bleeders, repair of DI, wedge lung resections and decortication. Mean postoperative length of stay was 5.86 days. There were no morbidities. One patient with severe intra-abdominal injuries expired on the first postoperative day. CONCLUSION: In hemodynamically stable patients with thoracic injuries, VATS provides an accurate assessment of intra-thoracic organ injury and can be utilized to definitively and effectively manage injuries sustained as a result of blunt or penetrating thoracic trauma. VATS should be used with caution in patients sustaining severe and life threatening intra-abdominal injuries.

Adolescent↗
PubMed1996

Complex thoracic injuries.

Complex thoracic injuries are a leading cause of death in trauma patients. Four difficult problems of diagnosis and treatment are discussed, including (1) air leak not associated with pneumothorax, (2) management of major thoracic esophageal injuries, (3) penetrating trauma, and (4) retained hemothorax and empyema.

Bronchi↗
PubMed1994

Surgical management of major thoracic injuries.

Major thoracic injuries are uncommon in the United Kingdom and wide experience of their management by centres in this country has not been reported. Between 1985 and 1990, 23 patients have undergone urgent thoracotomy at Birmingham Accident Hospital for suspected intrathoracic injury. The majority of these injuries were caused by penetrating trauma (13 patients). The commonest indications for thoracotomy were suspected intrathoracic haemorrhage in 13 patients and suspected cardiac tamponade in four patients. In three of the four patients with suspected cardiac tamponade, the diagnosis was correct, the tamponade successfully relieved together with repair of the lesion, and all three patients survived. Of the 13 patients with intrathoracic haemorrhage, 10 survived after control of haemorrhage and repair of the lesion but three died: one from uncontrollable haemorrhage from a right middle lobe vessel laceration, one from associated multiple injuries and one from post-operative complications. The TRISS methodology was applied to audit our results. Two patients who died after a penetrating injury had a greater than 50 per cent probability of death by the TRISS method. Two patients who died after a blunt injury had a less than 50 per cent probability of death by the TRISS method although one of these patients died from postoperative complications. This series illustrates the point that prompt recognition of a suspected intrathoracic injury and appropriate urgent surgical intervention to relieve cardiac tamponade and control intrathoracic haemorrhage in these patients can produce a successful outcome. In addition it it is essential that all units audit their own results in order to highlight areas where improvements in trauma care can be made.

Adolescent↗
PubMed2002

Traumatic injuries: imaging of thoracic injuries.

Chest trauma is one of the most important causes of death, in particular in individuals under the age of 40 years. The mortality rate for chest trauma, often related to motor vehicle accidents, is approximately 15.5%; it increases dramatically to 77% with associated shock and head injury (Glasgow scores of 3-4). The accurate diagnosis of pathologies consequent to blunt chest trauma depends on a complete knowledge of the different clinical and radiological manifestations. The first diagnostic approach is classically based on chest X-ray often carried out on supine position at the hospital admission. A CT study must then be performed in all chest trauma patients in whom there is even the smallest diagnostic doubt on plain film. In particular, spiral CT (SCT) assumes a fundamental role in the demonstration of mediastinal hemorrhage and direct signs of aortic lesions. At present, SCT is routinely part of a diagnostic evaluation which also includes scans of the brain and the abdomen in polytraumatized patients. Magnetic resonance is the ideal method for visualizing diaphragmatic lesions. Furthermore, recent reports have demonstrated the high diagnostic value of MR in evaluating aortic injuries. The purpose of this article is to review the most common radiological patterns related to chest trauma.

Accidents, Traffic↗
PubMed1996

[Heart injury following closed thoracic injury].

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open fracture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.

Arm Injuries↗
PubMed1994

[Personal experience in the treatment of injured patients with craniocerebral injuries associated with thoracic injuries].

In the Emergency Center of the Neurosurgical Intensive Care Unit Belgrade, in the one-year period (from January, 1st 1992 to December, 31st 1992), 54 injured patients with severe head injuries associated with chest trauma were treated. In all injured patients the following parameters were considered: sex, age, mechanism of injury, surgical procedures, and fatal outcome. Thirty-nine patients (72.22%) survived.

Adolescent↗
PubMed2002

[Experimental bases of a new method of epidural anesthesia in patients with closed thoracic injury].

The thoracic epidural block is the most effective method of anesthesia in patients with a closed mechanical trauma of the chest. But this method is associated with a risk of damage of the spinal cord. So it can be used but by highly qualified specialists. The authors have worked out a method of anesthesia of the thoracic segments based on the phenomenon of hydrolock. It is more simple, safe, easy for any specialist able to use the technique of routine lumbar epidural block.

Adult↗
PubMedDate not supplied

Videothoracoscopic evaluation of thoracic injuries.

Residual thoracic collections after thoracic traumas occur in 5-30% of patients and are a major risk factor for development of empyema. Management with a thoracostomy tube is the traditional treatment but it requires a prolonged hospital stay and 20% of patients treated continue to have a residual clot. Forty-two haemodynamically stable patients with chest trauma (36 blunt and 6 penetrating) were examined thoracoscopically. Indications for videothoracoscopy included suspected diaphragmatic injury (8 patients), persistent pneumothorax (8), continued haemorrhage (6) and clotted haemothorax (20). Diaphragmatic lacerations were confirmed thoracoscopically in 7 patients. Four of them were successfully repaired with thoracoscopic techniques and three were repaired after conversion to open thoracotomy for large diaphragmatic lacerations. In patients with persistent pneumothorax, limited lung lacerations were correctly diagnosed and repaired thoracoscopically. In all patients with continued haemorrhage intercostal artery injury was confirmed and repaired by diathermy. All clotted haemothorax cases were successfully evacuated. No complications occurred. Videothoracoscopy appears to be a safe, accurate and reliable operative therapy for the assessment of diaphragmatic injuries, control of continued bleeding and evacuation of clotted haemothorax, reducing the hospital stay and possible complications.

Adult↗
PubMed2004

Damage control surgery for thoracic injuries.

Damage control of thoracic injuries begins frequently with an emergency department thoracotomy via an anterolateral incision. Bleeding and air leaks are quickly temporised. As opposed to abdominal damage control where most injuries can be temporised, most thoracic injuries require initial definitive repair. Thus, the goal of thoracic damage control is to perform the least definitive repair using the fastest and easiest techniques to shorten the operative time as much as possible. There are some injuries that can be temporised and require re-operation once physiologic normality has been achieved.

Critical Care↗