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"Trauma" AND "Thoracotomy" AND "Emergency"

Lynn Hakki, Alison Smith, Jonathan Babin, John Hunt, Juan Duchesne, Patrick Greiffenstein
INTRODUCTION: Expanding or fragmenting bullets have been known to cause extensive injuries since they became available in the late 19th century. Although these bullets are now banned from international warfare, their use by civilians and law enforcement is still legal in the US. In this case report, we describe the complex injuries and subsequent complicated hospital course of a civilian trauma patient who was shot with a newly-designed fragmenting bullet, known as a Radically Invasive Projectile (RIP) bullet...
January 25, 2019: Injury
Maria J Mandt, Kari Hayes, Fred Severyn, Kathleen Adelgais
OBJECTIVE: Needle thoracostomy is a life-saving procedure. Advanced Trauma Life Support guidelines recommend insertion of a 5 cm, 14-gauge needle for pneumothorax decompression. High-risk complications can arise if utilizing an inappropriate needle size. No study exist evaluating appropriate needle length in pediatric patients. Utilizing computed tomography (CT), we determined the needle length required to access the pleural cavity in children matched to Broselow™ Pediatric Emergency Tape color...
January 9, 2019: Prehospital Emergency Care
David Carver, Andrew W Kirkpatrick, Scott D'Amours, S Morad Hameed, Julie Beveridge, Chad G Ball
OBJECTIVE: The primary objective of this study was to evaluate the utility, clinical impact, and work flow of a new trauma hybrid operating theater. SUMMARY BACKGROUND DATA: The potential utility and clinical benefit of hybrid operating theaters are increasingly postulated. Unfortunately, the clinical outcomes and efficiencies of these environments remain unclear. METHODS: All severely injured patients who were transferred to the hybrid suite for emergent intervention between 2013 and 2017 were compared to consecutive prehybrid patients...
December 20, 2018: Annals of Surgery
E Ter Avest, J Griggs, C Prentice, J Jeyanathan, R M Lyon
INTRODUCTION: Helicopter emergency medical services (HEMS) are often dispatched to patients in traumatic cardiac arrest (TCA) as they can provide treatments and advanced interventions in the pre-hospital environment that have the potential to contribute to an increased survival. This study, aimed to investigate the added value of HEMS in the treatment of TCA. METHODS: We performed a retrospective cohort study of all patients with a pre-hospital TCA who were attended by a non-urban HEMS (Kent, Surrey and Sussex Air Ambulance trust) between July 1st 2013 and May 1st 2018...
December 28, 2018: Resuscitation
E Ter Avest, J Griggs, C Prentice, J Jeyanathan, R M Lyon
INTRODUCTION: Helicopter emergency medical services (HEMS) are often dispatched to patients in traumatic cardiac arrest (TCA) as they can provide treatments and advanced interventions in the pre-hospital environment that have the potential to contribute to an increased survival. This study, aimed to investigate the added value of HEMS in the treatment of TCA. METHODS: We performed a retrospective cohort study of all patients with a pre-hospital TCA who were attended by a non-urban HEMS (Kent, Surrey and Sussex Air Ambulance trust) between July 1st 2013 and May 1st 2018...
December 28, 2018: Resuscitation
Edoardo Segalini, Luca Di Donato, Arianna Birindelli, Alice Piccinini, Alberto Casati, Carlo Coniglio, Salomone Di Saverio, Gregorio Tugnoli
The role of emergency thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only a small number of studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay were considered, as well as survival rate and neurological outcome...
December 26, 2018: Updates in Surgery
Dirk Stengel, Johannes Leisterer, Paula Ferrada, Axel Ekkernkamp, Sven Mutze, Alexander Hoenning
BACKGROUND: Point-of-care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma...
December 12, 2018: Cochrane Database of Systematic Reviews
Kaori Ito, Kahoko Nakazawa, Tsuyoshi Nagao, Hirohito Chiba, Yasufumi Miyake, Tetsuya Sakamoto, Takashi Fujita
BACKGROUND: Our institution has emergency rooms (ERs) with an operating room (OR) setup, which enables surgeons to perform thoracotomy and/or laparotomy for trauma patients without transferring patients to the OR. We hypothesized that the ERs with an OR setup improve the timeliness of surgery for trauma patients. MATERIALS AND METHODS: Data were reviewed from trauma patients who underwent emergency surgeries performed by our acute care surgery group from April 2013 to June 2017...
December 2018: Journal of Surgical Research
Bellal Joseph, Muhammad Khan, Faisal Jehan, Rifat Latifi, Peter Rhee
Background: Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT. Methods: A 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program...
2018: Trauma surgery & acute care open
Christopher J Goodenough, Tyler A Cobb, John B Holcomb
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become an increasingly popular alternative to emergency thoracotomy and aortic cross-clamping in patients with exsanguinating hemorrhage.1 This new capability is increasingly being used in non-trauma situations.2 3 This report demonstrates another novel use of REBOA for iatrogenic intra-abdominal hemorrhage. An 83-year-old man with multiple medical comorbidities and a history of chronic mesenteric ischemia was admitted to our institution for an elective mesenteric revascularization...
2018: Trauma surgery & acute care open
Antônio Oliveira de Araújo, Fernando Luiz Westphal, Luiz Carlos de Lima, Jéssica de Oliveira Correia, Pedro Henrique Gomes, Emanoel Nascimento Costa, Luciana Macedo Level Salomão, Cleinaldo Nascimento Costa
OBJECTIVE: to determine the frequency of fatal cardiac trauma in the city of Manaus, Brazil, between November 2015 and October 2016, and to clarify the mechanisms of trauma and death, previous hospital treatment, as well as the injuries associated with cardiac trauma. METHODS: retrospective, observational, and cross-sectional study, which reviewed the necropsy reports of individuals whose cause of death was cardiac injury. RESULTS: the cardiac trauma rate was of 5...
October 4, 2018: Revista do Colégio Brasileiro de Cirurgiões
Koshi Ota, Satoshi Fumimoto, Ryo Iida, Takayuki Kataoka, Kanna Ota, Kohei Taniguchi, Nobuharu Hanaoka, Akira Takasu
BACKGROUND: Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured. We report a case of massive hemothorax with bleeding from the intercostal artery and diaphragmatic damage caused by minor blunt trauma. CASE PRESENTATION: An 83-year-old Japanese man was transported to our hospital 3 hours after falling out of bed. Computed tomography revealed hemothorax and multiple rib fractures. He underwent fluid resuscitation and a tube thoracostomy, but he became hemodynamically unstable...
October 7, 2018: Journal of Medical Case Reports
Kenji Kandori, Wataru Ishii, Ryoji Iiduka
INTRODUCTION: Systemic arterial air embolism (SAAE) is a rare but fatal condition, with only a few cases reported, and the detailed etiology underlying SAAE remains unknown. We report a first case of massive SAAE after blunt chest injury, wherein the presence of traumatic air shunt was confirmed by direct observation during surgery. We also summarize our experience with six other SAAE cases. PRESENTATION OF CASE: A 68-year-old woman was admitted in a state of cardiac arrest after a fall...
2018: International Journal of Surgery Case Reports
Fareed Cheema, Carrie Garcia, Aksim G Rivera, Edward Chao
: Hemorrhage is the leading cause of preventable death in trauma patients. In recent years, technological innovations and research efforts aimed at preventing death from hemorrhagic shock have resulted in the emergence of resuscitative endovascular balloon occlusion of the aorta (REBOA). REBOA offers a less invasive option for emergent hemorrhage control in noncompressible areas of the body without the added risks and morbidities of an ED thoracotomy. This article outlines the procedure and device used, describes the procedure's evolution, and discusses various considerations, pitfalls, and nursing implications...
October 2018: American Journal of Nursing
Tristan Monchal, Matthew J Martin, Jared L Antevil, Donald R Bennett, William C DeVries, Scott Zakaluzny, Robert L Ricca, Homer Tien, Philip S Mullenix, Zsolt T Stockinger
Resuscitative thoracotomy has been extensively described in the civilian trauma literature and has a high mortality rate, due largely to the nature of the injuries leading to arrest. The survival rates are generally highest (10-30%) for penetrating truncal injuries and patients who arrive with vital signs and proceed to arrest or who have impending arrest. They are significantly lower (less than 5%) for blunt trauma victims, particularly those who arrest in the field or during transport (1% or less). In addition, the likelihood of survival with intact neurologic function is significantly lower than the overall survival rates, particularly for blunt trauma victims and for prehospital arrest...
September 1, 2018: Military Medicine
Craig Prentice, Jeyasankar Jeyanathan, Richard De Coverly, Julia Williams, Richard Lyon
OBJECTIVES: The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. SETTING: Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people. PARTICIPANTS: Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust's geographical region were identified...
September 5, 2018: BMJ Open
Omer Ehsan, Usama Khalid Choudry, Atif Rana, Zahid Amin Khan
Traumatic aortic injury (TAI) or aortic transection is the second most common cause of death after blunt trauma. The conventional management approach towards a thoracic aortic injury is open thoracotomy and surgical repair; however, there is a recent increase in the trend towards the use of endovascular approach in this regard, particularly in the developed countries. We here report the cases of two young healthy male patients presenting in emergency department with thoracic aortic injury, following a road traffic accident (RTA)...
September 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Scott D Steenburg, Tracy Spitzer, Amy Rhodes
PURPOSE: To describe our institutional experience with post-mortem computed tomography (PMCT) and its impact on decedent injury severity score (ISS) and to assess the adequacy of emergently placed support medical devices. METHODS: Over a 5-year period, patients who died at or soon after arrival and have physical exam findings inconsistent with death were candidates for inclusion. Whole body CT was performed without contrast with support medical devices left in place...
August 29, 2018: Emergency Radiology
Patrick Schober, Marcel A de Leeuw, Maartje Terra, Stephan A Loer, Lothar A Schwarte
Clamshell thoracotomy (CST) may be indicated and life-saving in carefully selected cases of blunt trauma. As such, the current clinical stance of general contraindication of CST in blunt trauma should be reviewed and criteria developed to accommodate select cases, considering the diversity of injuries resulting from blunt trauma.
August 2018: Clinical Case Reports
Yosuke Matsumura, Junichi Matsumoto, Hiroshi Kondo, Koji Idoguchi, Tokiya Ishida, Yohei Okada, Yuri Kon, Kazuyuki Oka, Kenichiro Ishida, Yukitoshi Toyoda, Tomohiro Funabiki
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in refractory hemorrhagic shock patients. Since the optimal timing of arterial access remains unclear, we evaluated the preocclusion status of patients, and elapsed time from the arrival to the hospital is associated with the survival outcomes in the REBOA patients. METHODS: From August 2011 to December 2016, The Diagnostic and Interventional Radiology in Emergency, Critical care and Trauma-Intra-Aortic Balloon Occlusion (DIRECT-IABO) investigators registered refractory hemorrhagic shock patients undergoing REBOA from 23 hospitals in Japan...
September 2018: Journal of Trauma and Acute Care Surgery
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