[Nursing of a patient with a thoracic injury--a case of a penetrating thoracic injury].
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Adult↗
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Multiple injuries: coma and thoracic injury.
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Adult↗
Indications for thoracotomy following penetrating thoracic injury.
The treatment of penetrating thoracic injuries has been reviewed in both civilian and military series. Although most surgeons agree that closed that closed thoracostomy drainage is the initial treatment of choice, the timing of early thoracotomy and perhaps cardiorrhaphy upon patients with penetrating thoracic injuries remains controversial. The purpose of this study was to determine which patients will require immediate thoractomy or cardiorrhaphy following penetrating chest injury. Over a two-year period 190 patients with penetrating thoracic injuries were treated. Of 53 patients who required immediate thoracotomy, 31 suffered cardiac wounds. Seventy-nine patients required laparotomy for associated intra-abdominal injuries. The mortality rate was related to exsanguinating hemorrhage or postoperative intra-abdominal sepsis. Cardiopulmonary complications were rare in the absence of intra-abdominal sepsis and could not be attributed to the thoracic injury or thoracotomy. Indications for immediate cardiorrhaphy or thoracotomy are: 1) location of the entrance wound (70% in upper mediastinum); 2) blood pressure on admission less than 90; 3) initial thoracostomy blood loss greater than 800 cc; 4) radiographic evidence of retained hemothorax; and/or 5) clinical evidence of pericardial tamponade.
Drainage↗
[Characteristics of diagnosis and surgical tactics in penetrating thoracic injuries].
The penetrating thoracic injury was observed in 355 patients. Primary debridement (PD) of a wound was performed in 23, PD and closed drainage of the pleural cavity--in 33, PD with subsequent thoracotomy--in 42, thoracotomy--in 257 patients. Injury to the lung was observed in 185 patients, heart--in 46, major vessels--in 9, thoraco-abdominal--in 47. Complications occurred in 54 (15.2%) patients: in 8--continued bleeding, in 21--pneumonia, in 19--pyothorax, in 6--wound suppuration and costal osteomyelitis. Eighteen (5%) patients died: 15--from hemorrhagic shock and massive bleeding, 2--from sepsis and abscessed pneumonia, 1--from peritonitis and intraabdominal bleeding.
Adolescent↗
[Thoracotomies in thoracic injuries--indications and results].
Most thoracic injuries can be treated adequately with intensive care, pleural drainage and judicious physiotherapy. From the total of 571 patients with severe thoracic injuries treated in the Surgical Department of the University of Cologne over the last 10 years, 14% of those with blunt trauma (BT) and 33% with penetrating trauma (PT) underwent thoracotomy. Thoracotomy for PT was usually performed earlier and gave better results than thoracotomy for BT. With one exception, all PT underwent thoracotomy in the first 24 h after admission. For thoracotomy carried out for BT however, 38% took place after 24 h and 21% after 5 days. Postoperative mortality for BT was 3 times higher than for PT (56% vs. 18%). Reasons for this are to be found in the severe thoracic and general injuries associated with BT. The surgical procedure will depend on the type and extent of the thoracic and general injuries and on the general condition of the patient.
Adolescent↗
[Characteristics of thoracic injuries in children].
Thoracic trauma is uncommon in children. It should not be managed any more as adult's trauma. We present our experience with 85 children form 1 to 16 years of age, presenting severe thoracic trauma treated in Lausanne, Switzerland, between 1976 and 1990. The specific features of diagnosis, treatment and outcome are presented. Most of them were involved in traffic accidents (62%), 55% had multisystemic injuries. The mortality rate was not a function of the Injury Seventy Score as in adults, but was only related to the Glasgow Score. Only 3 patients (3.5%) had hemodynamic instability on admission in relation with their thoracic injury. Patients with intrathoracic lesions showed dyspnoea (65%), cyanosis (25%), or clinical suspicion of a pleural effusion or a pneumothorax (47%). However 12 children had an asymptomatic severe thoracic injury. In 53 patients (62%) the auscultation was found abnormal either with absent or diminished breath sounds or other pathological findings. 10 out of 26 cases of pneumothorax could be suspected by percussion dullness. Chest X-rays showed a lesion in 76% of cases. Only 30% of the pneumothorax were associated with visible rib fractures. 10 children suffered from 4 to 12 fractures of the ribs (mean 6.6). None of these patients presented a flail chest as in adults, even when multiple rib fractures existed. 31 thoracic drainages were performed, during a mean period of 3.3 days. 30 patients were intubated and ventilated, 22 of these due to a neurosurgical condition. All patients had physiotherapy starting on day 2, under analgesia if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Traumatic mediastinal lymphocele mimicking other thoracic injuries: case report.
Thoracic duct injury and chylothorax are rare consequences of blunt thoracic trauma. A contained mediastinal lymph collection (ie, lymphocele) is rarer still. The article describes a case of posttraumatic mediastinal widening resulting from a high-speed motor vehicle accident. During the patient's radiologic assessment aortic rupture, paraspinal hematoma, esophageal injury, mediastinal tumor, and pseudomeningocele were sought and subsequently excluded. At this point a traumatic lymphocele was suggested, and the diagnosis was confirmed by computed tomography-guided percutaneous needle aspiration. The anatomy and physiology of the thoracic duct are reviewed.
Adult↗
[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↗
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↗
[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↗
[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↗
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↗
[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↗
[Acute thoracotomy in thoracic injuries].
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Humans↗
[Practical aspects of thoracic injuries].
While mortality is about one per hundred in patients with injuries to the chest wall it is one in five in patients with internal thoracic injuries. The mortality is dependent on the total severity of injuries, and upon age. Closed, blunt thoracic trauma may initially present few signs and symptoms. Internal injuries, such as pneumothorax and haemothorax may be present. Decompression by thoracic drainage improves oxygenation. This may be crucial for the prognosis in multitrauma, particularly in cases of concomitant head injury. Treatment and diagnosis of thoracic injuries have first priority in the multitraumatized patient. A chest X-ray should be obtained early, and should be repeated, possibly supplemented by a CT-scan. When pneumothorax or haemothorax is suspected, and in cases of penetrating injury, chest drainage is widely used. In cases of chest injury and unexplained shock, cardiac tamponade must be excluded by subxiphoidal incision.
Drainage↗
[Clinical aspects, diagnosis and treatment of cranio-thoracic injuries in patients of different age].
The comparative analysis of the clinical manifestations and informative value of the adjuvant methods of investigation in 125 patients with ++cranio-thoracic injuries and 53 patients with isolated craniocerebral trauma was carried out. This permitted to define more precisely the possibilities of the methods of neurosurgical diagnosis and find the optimal methods for the treatment of patients of different age with ++cranio-thoracic injuries.
Adult↗
[Blunt thoracic injuries in Oslo].
All 327 patients treated in Oslo City Hospital for blunt chest injuries during a period of three months were registered prospectively. 274 were treated outside hospital. Traffic accidents accounted for 10% of the total number of patients, but 40% of the hospitalized patients. Accidents in the home were most numerous, with many complications and admissions to hospital. 20% of the hospitalizations, were for injuries due to violence. The registration indicates more than 1,300 patients with chest injuries per year, of whom more than 40 are severely multitraumatized. The chest injury was serious in 21 patients, moderate in 306. 13.5% of the cases were complicated by pneumo-hemothorax and lung contusion, or by late complications such as pneumonia and atelectases. Seven patients (2.1%) died. These were old, physically disabled or multitraumatized. 100 patients had extrathoracic injuries, of whom 15 had intrathoracic injuries as well. In 227 patients with thoracic injuries only, the injuries were intrathoracic in six of them. The mortality in patients with chest wall injuries only was 0.7%, as compared with 20% in patients with intrathoracic injuries.
Accidents↗
[X-ray computed tomography of thoracic injuries. Apropos of 40 cases].
On chest radiographs, the precise assessment of thoracic injuries consecutive to blunt trauma is often compromised by the nonspecific appearance of many lesions. Furthermore, significant injuries are frequently overlooked. However, the management of the patients with chest trauma is still often based primarily upon clinical and radiographic findings and Computed Tomography (CT) is often performed secondarily on the basis of unexplained clinical signs or suspected radiographic abnormality. Some authors have reported that CT was a highly sensitive method for detecting thoracic lesions frequently not seen or underestimated on conventional supine chest radiographs. However, the value that these new CT findings could have in the therapeutic management of these patients, have not been systematically investigated to our knowledge, except in a limited series suggesting that the course of critically ill patients could be substantially altered after thoracic CT. In order to estimate the role of early CT in the management of patient care, we report the therapeutic consequences of CT findings in forty patients who we report the therapeutic consequences of CT findings in forty patients who had a thoracic CT within few hours following a chest injury. We showed that early thoracic CT scan in patients with blunt trauma detected significantly more lesions than did chest X-Ray and appreciably modified the treatment modalities in 70% of our patients. We then recommend that all the patients admitted in ICU after chest trauma undergo a thoracic CT scan as soon as possible in order to optimize their treatment modalities.
Adolescent↗