Penetrating Chest Injury Research Articles

029. Management of Injury to The Right Lung Due to Penetrating Trauma to The Chest: A Case Report

Background: Thoracic trauma is a significant cause of mortality, in fact, many patients with thoracic trauma die after reaching the hospital. However, many of these deaths can prevented with prompt diagnosis and treatment. Less than 10% of blunt chest injuries and only 15 to 30% of penetrating chest injuries require operative intervention. Most patients who sustain thoracic trauma can be treated by technical procedures within the capabilities of trained clinicians. Case: We reported a case of 44-year-old female having a penetrating wound in her left chest because of her ex-husband stabbed her with a knife. The patient felt pain and the vital signs were stable, from the physical examination there were no abnormalities found. The surgeons did anterior thoracotomy and evacuated the knife within 2 hours since the patient arrived in the ER, and turned out the knife injured the right lung and there was bronchopleural fistula appeared. The surgeons did repair of the fistula and debridement of the wound and primary suturing carried out. The patient discharged 3 days after hospitalized with good clinical condition. Conclusion: This case report presents a successful management of a stable patient with penetrating chest trauma.

Epidemiology of Penetrating Chest Injuries Presenting at a Tertiary Care Center in Peshawar: A Retrospective Study.

Trauma is the leading cause of mortality globally.Penetrating chest trauma is a type ofinjury that occurs when an object pierces the skin and enters the chest wall. The incidence of penetrating chest trauma is high in the Khyber Pakhtunkhwa Province of Pakistan, with firearm injuries being the most common cause. The objective of this study is to determine the epidemiology and outcome of non-cardiac penetrating chest injuries presented at a tertiary care center in Peshawar. This retrospective cohort study was conducted from January 2022 to January 2023 at Medical Teaching Institute, Lady Reading Hospital, Peshawar, KPK, Pakistan. Two hundred and three patients who suffered penetrating chest trauma in the Khyber Province of Pakistan between January 2022 and January 2023 were included in this retrospective cohort study. The epidemiology and outcomes were analyzed using IBMSPSSStatistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). The mean age of the patients was 30.25 ± 16.674 years. Males comprised 183 (90.1%) of the study sample whereas females comprised only one-tenth 20 (9.9%). Gunshot injuries were the predominant mode of penetrating thoracic trauma comprising 128 (63.05%) of all injuries. Injuries inflicted by knife constituted approximately one-fifth of the presentations 44 (21.67%). The remaining injuries labeled 'Others' comprised modes such as road traffic accidents and fall injuries where the predominant mechanism was penetrating injury. The latter comprised 31 (15.27%) of the injuries. Penetrating chest trauma is common in the Khyber Pakhtunkhwa Province of Pakistan. Gunshot injury is the most common mode. Males are predominantly affected. Most non-cardiac penetrating chest trauma can be managed conservatively.

Large Pulmonary Bullae, Resulting from Tuberculosis, in the Context of Extensive Pneumothorax Caused by a Penetrating Chest Wound

Pulmonary bullae typically occur either idiopathically or in the context of chronic obstructive pulmonary disease and pulmonary infections. Clinical manifestations of pulmonary bullae include cough, shortness of breath, and chest pain. In some cases, they may be asymptomatic. Differentiating between pneumothorax and pulmonary bullae can be challenging when they coexist. Therefore, obtaining a detailed patient history, conducting a physical examination, performing laboratory tests, and utilizing radiology studies are essential diagnostic tools that should be employed simultaneously. In this case report, we present a patient who developed a wide pneumothorax due to a penetrating chest wound caused by a knife. Initially, the large lung cavity, which had already formed due to tuberculosis, was misdiagnosed as a loculated pneumothorax.

The use of minimally invasive surgical procedures in complications of combat thoracic trauma

Background. The incidence of chest injuries in the overall structure of combat surgical trauma is approximately 4 % in present-day military conflicts, and according to the data from Anti-Terrorist Operation/Joint Forces Operation in the Eastern Ukraine, it varies from 7.5 to 11.7 %. In case of penetrating chest injuries, the overall mortality reaches 10 %. Objective: to improve the treatment outcomes in chest injuries through the application of endovideosurgical technologies and local fibrinolytic therapy during the quaternary care in complications of combat thoracic trauma. Materials and methods. A clinical statistical analysis of the surgical outcomes was conducted in 103 victims with combat chest trauma, who received specialized thoracic surgical treatment for complications such as clotted hemothorax at the quaternary care level. The control group included 54 (52.4 %) casualties, and the experimental group included 49 (47.6 %). Results. According to the research findings, among the total number of chest injuries and traumas, lung injuries were the most common, accounting for 61.2 %. In the experimental group, lung injuries were identified in 27 cases. When analyzing the treatment of thoracic injuries and traumas in the control group, it was found that 21 (38.9 %) patients did not have sufficient pleural cavity drainage during the provision of primary medical and qualified care to eliminate hemo- and pneumothorax, and 33 (61.1 %) required various surgical procedures through thoracotomy accesses. Videothoracoscopy was performed in casualties with gunshot penetrating chest injuries, when metal fragments were located in the anterior mediastinum (between the sternum and ascending aorta) and posterior mediastinum (between the right main bronchus and esophagus, without damage to them). The removal of metal fragments from the mediastinum, sanitation, and drainage of the pleural cavity were performed. Among 26 casualties, who underwent pleural drainage, 4 patients have had unstable vacuum in the pleural cavity for three days. Conclusions. The implementation of the developed differentiated surgical approaches in the patients with chest injuries and clotted hemothorax contributed to a reduction in specific injury complications from 24.1 to 8.2 % and allowed for a decrease in the duration of hospital stay from 24 to 16 bed-days.

A case of using minimally invasive techniques in a gunshot wound to the chest with mediastinal injury

Background. In modern military conflicts, the frequency of gunshot wounds to the chest is 8–12 %, of which 79.4 % are non-penetrating, and 20.4 % are penetrating with damage to intrathoracic organs. The most challenging task is to choose an approach to penetrating chest wounds due to the inability of verifying the anatomical and topographic nature of the chest wound by non-invasive methods before surgery. At present, there is a tendency to a widespread use of minimally invasive techniques in all areas of surgery. So, the aim of the study is to demonstrate the options of minimally invasive techniques in the diagnosis and treatment of gunshot wounds to the chest with mediastinal damage. Materials and ­methods. Patient G., 36 years old, was wounded to the chest and delivered an hour after the injury to the frontline surgical unit in the state of moderate severity, where he underwent left thoracentesis and pleural drainage. In 4 hours, he was taken to the Military Medical Clinical Center of the Northern Region of the Armed Forces of Ukraine and hospitalized to the emergency department. Diagnosis was made of gunshot shrapnel penetrating wound to the left chest with damage to the upper lobe of the left lung and mediastinum. A foreign body (metal fragment) in the mediastinum. Left-sided hemothorax (300 ml), post-traumatic pneumonitis. Surgery: left thoracentesis, drainage of the pleural cavity by Bülau. A chest and abdominal ultrasound were performed according to the FAST protocol. Laboratory tests were carried out: complete blood count, urinalysis, biochemical blood test, blood coagulogram. Multislice computed tomography of the head, chest, abdomen, and pelvis was performed, as well as video-assisted esophagogastroduodenoscopy and thoracoscopy. Surgical treatment consisted in video-assisted thoracoscopy, revision of the left pleural cavity, removal of a foreign body (metal fragment) from the mediastinum, sanitation and repeated drainage of the left pleural cavity according to Bülau. A foreign body (metal fragment) was removed using a magnetic instrument for endovideoscopic diagnosis and removal of metal ferromagnetic foreign bodies from the abdominal and pleural cavities. Results. Data of multislice computed tomography of the chest on admission were as follows: a 10 × 5 mm metal fragment near the pulmonary artery, post-traumatic pneumonitis along the wound channel. A video-assisted esophagogastroduodenoscopy was done, and esophageal damage was excluded. Surgery was performed: video-assisted thoracoscopy, revision of the left pleural cavity, removal of a foreign body (metal fragment) from the mediastinum, sanitation and repeated drainage of the left pleural cavity according to Bülau. The surgical intervention lasted 30 minutes. On the second day, the drain tube was removed from the pleural cavity. Subsequently, 2 weeks later, the sutures were removed, the wounded man was presented to the military medical commission and discharged to the unit. Conclusion. Gunshot wounds to the chest with mediastinal damage are rare. The use of a modern magnetic surgical instrument allows the removal of ferromagnetic foreign bodies in case of mediastinal injury. The use of minimally invasive surgical interventions for gunshot wounds to the chest with mediastinal injury reduces surgical trauma and can be applied at a specialized level of medical care.

Penetrating chest injury secondary to an improvised home-made marble airgun: a case report

BackgroundAn improvised air gun with marble bullets, locally known as “Jolen Gun”, is a type of home-made gun using Polyvinyl chloride (PVC) pipes and compressed air. It is mainly being...

Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 – 2017

BackgroundTrauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe – with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. MethodsFor this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score ≥ IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. ResultsWe included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. ConclusionsSevere cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. Trial registrationRetrospective analysis without intervention.

Clinical application of neodymium magnetic instruments for the removal of foreign bodies in blind wounds

A feature of modern military conflicts is the high frequency of shrapnel wounds. The search for foreign bodies, even under X-ray navigation, can be technically difficult, lengthy and not always successful. Most injuring objects have ferromagnetic properties.&#x0D; AIM: The Military Medical Academy, Saint Petersburg purpose of the study: to evaluate the effectiveness of removing ferromagnetic foreign bodies from blind wounds using neodymium magnetic instruments.&#x0D; MATERIALS AND METHODS: Instruments based on a neodymium magnet for removing foreign bodies and a technique for their use have been developed. An analysis was made of 45 operations where traditional instruments were used and 75 operations using original magnetic instruments. Of these, in 40 cases of blind wounds, foreign bodies were removed from the soft tissues of various areas, and in 35 cases, foreign bodies were removed during videothoracoscopy operations for blind penetrating chest wounds. The criteria for evaluating the effectiveness of the method were the duration of the operation, the duration of work with the X-ray unit and the number of detected and removed foreign bodies in a fixed period of time.&#x0D; CONCLUSION: High efficiency, simplicity, accessibility, minimally invasiveness of the developed instruments have been proven. Neodymium magnets made it possible to reduce the time of radiation exposure and the duration of the operation, to increase the efficiency of removing ferromagnetic foreign bodies. The use of original instruments makes it possible to detect 80% of foreign bodies in 10 minutes, and within 30 minutes to remove 90% of foreign bodies from the soft tissues of the wounded. With videothoracoscopy, the time of fluoroscopy was halved, and the total duration of the surgical intervention was reduced by 40%.

Functional disorders of the respiratory system in combat chest injury

Background. Gunshot injuries occupy one of the leading places in a number of injuries (combat injuries) that occur in military conflicts.&#x0D; Aim. To study the effect of gunshot wounds of the chest (penetrating and non-penetrating), as well as closed chest trauma on the respiratory function.&#x0D; Materials and methods. The study included 78 patients with a diagnosis of combined trauma, including a gunshot penetrating/non-penetrating wound of the chest or closed chest injuries. The median period from injury to the time of lung function tests was 17 [15; 22] days.&#x0D; Results. A prospective cross-sectional study was performed. All patients (100% males) underwent spirometry, body plethysmography, and diffusion test. The total sample was divided into two groups: group 1 (median age 27.5 [23.0; 36.0] years) 68 patients with gunshot penetrating chest wound, group 2 (median age 26.5 [20.0; 30.5] years) 10 patients with gunshot non-penetrating wound or closed chest trauma. In group 1, the medians of the vital capacity, forced vital capacity, inspiratory capacity, forced exhalation volume in 1 second, lung diffusion capacity (determined by the value of the carbon monoxide transfer-factor DLCO) and alveolar volume were reduced. In group 2, pulmonary ventilation parameters were within normal values while the median of DLCO was reduced. There were no statistically significant differences between the groups.&#x0D; Conclusion. Both gunshot penetrating wounds of the chest and gunshot non-penetrating wounds of the chest and closed chest injuries have a negative impact, including on the respiratory function, to a greater extent on lung diffusion capacity. It is necessary to create programs of drug correction and longer rehabilitation treatment of this category of patients.

Outcomes of resuscitative and emergent thoracotomies following injury at the largest trauma center in Estonia.

An emergency department thoracotomy (EDT) is performed in critically injured patients after a recent or in an imminent cardiac arrest following trauma. Emergent thoracotomy (ET) or operation room thoracotomy is reserved for more stable patients. However, the number of these interventions performed in an European settings is limited. Thus, we initiated the current study to investigate outcomes and risk factors for mortality of patients required EDT or ET at the largest trauma center in Estonia. All patients admitted after trauma to the North Estonia Medical Centre between 1/1/2017 and 31/12/2021 subjected to EDT or ET were included. Primary outcome was 30-day mortality. Overall, 39 patients were included. EDT and ET were performed in 16 and 23 patients, respectively. Median age was 45 (33-53) years and 89.7% were males. The crude 30-day mortality was 56.4% being 87.5% and 34.8% in the EDT and ET group, respectively. None of the patients with pre-hospital CPR requirement, severe head injury (AIS head ≥ 3) or severe abdominal injury (AIS abdomen ≥ 3) survived. All the patients in the survival group had signs of life in the emergency department. The rate of stab wounds was significantly higher in the survival group (p = 0.007). Patients with CGS < 9 had significantly lower possibility for survival (p < 0.001). EDT and ET outcomes in Estonian trauma system are comparable to similar advanced trauma systems in Europe. Patients with GCS > 8, signs of life in the ED and with isolated penetrating chest injury had the most favorable outcomes.

Clinical profile of chest trauma patients in a tertiary care center: a prospective observational study

BACKGROUND: Road traffic accidents form a major epidemic in the current century. The economic loss estimated to our country due to accidents amounts to Rs.5000 crores annually. Chest trauma estimates at about 50% of the total victims and 25% causative agent of mortality. Less than 10% of the blunt chest injuries and only 15 to 30% of penetrating chest injuries require operative intervention.METHODS: The present study is a prospective observational study that emphasizes on the epidemiology and the clinical profile of chest trauma patients that presented to the Himalayan Hospital over a period of 1 year.RESULTS: Chest Injury was encountered in about 20% of all trauma admissions with RTA (61%) being the major cause followed by Fall from height (30%). Fracture of the ribs was the most common chest injury. Blunt trauma abdomen and Neuro trauma were the most common associated injuries in polytrauma cases. Inter costal tube drainage (ICD) was the main stay of treatment in 84% of the cases.CONCLUSIONS: Epidemiologically thoracic injuries are one of the major causes of death in the younger age group. These injuries may present at varied timeframes and with vast variety of signs. Early identification and Prompt emergency management have proven to be of positive value in curing patients and decreasing their hospital stay.

Penetrating chest injury.

A 33-year-old man presented to the emergency department with a 24-hour history of chest pain and dyspnea after an accidental penetrating chest trauma while working in construction. He lived in a rural area. He had no known medical history. His heart rate was 113 beats per minute, blood pressure 106/64 mmHg, respiratory rate 24 breaths per minute, and oxygen saturation was 89%. On physical examination, he appeared well, had a left parasternal wound without active bleeding, and a decreased breath sound in the left lung field, without jugular ingurgitation. A contrasted computed tomography (CT) was requested (Figures 1 and 2). Traumatic intraventricular foreign body. CT revealed a linear structure with metallic density across the fourth costal arc and his left ventricle, associated with pericardial effusion and left hemothorax. An emergency sternotomy was performed, and findings confirmed an injury of 1 cm diameter by a screw on the left ventricle, without coronary injuries; additionally, he required left thoracostomy, and pericardial and mediastinal drainage. Echocardiography 12 hours later informed a normal ventricular function without a segmentary defect, pericardial effusion, or valvular damage. Clinicians should have a high index of suspicion of a life-threatening condition, even if the injury is due to a low-energy trauma. At 4 days follow-up hospitalization without complications, the patient was discharged in good condition. Penetrating chest trauma is a surgical emergency, with a high risk of complications and death.1 Low energy injuries occurring due to non-explosive objects are a rare event.2 Multidetector CT may be essential to confirm the diagnosis and specify the location and additional findings that allow defining the most appropriate treatment.3 The authors received no financial support for the research, authorship, or publication of this article.

超音波検査が診断に有用であった心嚢気腫による心タンポナーデの1例(Ultrasonographic diagnosis of cardiac tamponade due to pneumopericardium: a case report)

要旨 鋭的胸部外傷に伴う心嚢気腫は稀であるが，閉塞性ショックを生じうる緊急性の高い病態である。症例は80歳の男性。自殺企図による頸部刺創，胸部刺創でドクターヘリが要請された。病院前医療で気管損傷，左開放性血気胸に対して，気管挿管，刺創部の3点テーピング，左胸腔ドレナージを施行し当院へ搬送となった。来院後に血圧が低下し超音波検査で心嚢気腫による心タンポナーデを来していると考え，刺創部より用指的に緊急脱気を行い，速やかに血圧の上昇を得た。同日に永久気管孔を作成した。その後，心電図上ST上昇が見られたが，心筋逸脱酵素の上昇はなく冠動脈造影では冠動脈損傷などの所見はなかった。第12病日に胸腔ドレーンを抜去し，第21病日に耳鼻咽喉科へ転科し，第39病日に独歩で自宅退院した。本症例では，鋭的胸部外傷で来院後，超音波検査で心嚢気腫を疑い，心タンポナーデを来したが速やかに用指的に解除できたことが救命につながったと考えられる。

Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients.

Management of penetrating chest injuries with a positive pericardial window (PW) are presumed cardiac injuries and traditionally result in sternotomy. However, there is some evidence in the literature that select patients can be managed with PW, lavage, and drainage (PWLD). All patients with penetrating chest trauma who underwent PW and/or sternotomy over a 5-year period were identified. Patients were stratified by operative intervention [PW + sternotomy vs PWLD] and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of therapeutic sternotomy. Of the 146 patients who underwent PW and/or sternotomy included in the study, 126 patients underwent PW, 39 underwent sternotomy, and 10 underwent PWLD. There was no difference in demographics, LOS, ICU LOS, vent days, or mortality in patients who underwent PW + sternotomy, compared to patients who underwent PWLD. In the PWLD group, one patient returned to the OR for recurrent pericardial effusion and no patients required sternotomy. Multivariable logistic regression identified ISS as an independent predictor of therapeutic sternotomy (OR 1.160; 95% CI 1.006-1.338, P = .0616). Interestingly, positive FAST, significant CT findings, and trajectory were not predictors of therapeutic sternotomy. There were 7 patients with a left hemothorax and negative FAST found to have a positive PW and cardiac injury mandating sternotomy and repair. Penetrating cardiac injury can be managed with PWLD in select patients. Positive FAST, significant findings on CT, and trajectory do not mandate sternotomy. A negative FAST in the setting of a hemothorax does not rule out a cardiac injury.

Evaluation of the Spiral Chest CT Scan Findings in Patients with Multiple Trauma.

To evaluate the spiral chest computed tomography (CT) scan findings in patients with multiple trauma during the COVID-19 pandemic. This retrospective study was performed on multiple trauma patients admitted to a tertiary hospital in the north of Iran in 2020. All patients with multiple trauma who had undergone a chest spiral CT were included in this study. Furthermore, the data analysis was performed through descriptive and analytical statistics using SPSS software. A total of 600 patients were included over the study period. The mean age of patients was 48.2±20.3 years. Of the total, 496 (65.3%) patients had blunt chest injuries, and 104 (34.7%) had penetrating chest injuries. Falling was the most common mechanical cause of chest trauma in 270 patients (45%). Surgical interventions were performed in 110 (18.3%) patients. A total of 276 (46%) patients had chest injuries identified by CT scans. Many patients (15.6%) had ground-glass lung opacity in the CT scan reports. Lung consolidation, pneumothorax, lung contusion, hemothorax, and rib fractures were the most common. Due to the high frequency of typical findings in spiral CT scan examinations, obtaining a reliable history of trauma severity, injury mechanism, and a detailed physical examination is recommended before prescribing a CT scan for patients.

ТРАВМАТИЧНИЙ ПНЕВМОНІТ ВНАСЛІДОК ВІЙСЬКОВОЇ ТРАВМИ ГРУДНОЇ КЛІТКИ ЯК ФАКТОР РИЗИКУ ПНЕВМОНІЇ

The relevance of the problem of gunshot wounds and injuries as a result of the war with Russia continues to grow. Gunshot wounds and chest injury can cause several life-threatening conditions: bleeding, airway obstruction, tension pneumothorax with pericardial tamponade, open pneumothorax, massive hemothorax, chest dissection, tracheobronchial injury, diaphragm damage, myocardial injury, rupture thoracic aorta, esophageal damage and lung contusion. Lung contusion or traumatic pneumonitis is characterized by hemorrhage and swelling in the alveoli. This causes respiratory distress which develops 24 hours after lung injury, causing perfusion/ventilation mismatch by increasing pulmonary vascular resistance and decreasing lung compliance. From February 24, 2022 to February 18, 2023, in the Pulmonology Department of Volyn Regional Clinical Hospital, the rate of hospitalized military patients with chest injury due to mine-explosive wounds, shrapnel wounds, gunshot bullet wounds, and stub-cut wounds of the chest amounted to 19.3% of all pulmonary cases among military, admitted this year (n=88). Penetrating chest injury occurred in 41.1% of cases, nonpenetrating blunt chest injury (including behind armor blunt trauma) in 23.5 % of cases, chest trauma with soft tissue injury in 35.2 % of cases. Chest injury with fractured chest bones was detected in 47% of cases. In 52.9 % of cases, chest injuries and one stab-cut wound were on the side surface and chest, which was not protected by a bulletproof vest. Lung contusion or traumatic pneumonitis was observed in 70.5% of cases, including destruction in 29.4 %. Post-traumatic pneumonia was observed in 58.8 % of cases, that was caused by a non-hospital and hospital infection, pleurisy was observed in 17.6 % of cases. After chest injury, infiltrative-destructive pulmonary tuberculosis was detected in 5.8 % of cases and invasive pulmonary aspergillosis in 5.8 % of cases. Thus, the occurrence of a specific infection that can lead to destruction and aggravate destructive changes in the lung parenchyma should also be taken into account. Also, in 64.7 % of cases, metal, fragmentary, foreign bodies of the chest organs were found, and required further surgical removal. The article presents clinical cases of patients with chest injuries received as a result of military operations in Ukraine. Key words: traumatic pneumonitis, lung contusion, gunshot wound, chest injury, behind armor blunt trauma, pneumonia.

No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial.

To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC). Patients of age 15years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups. Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established. Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

Clinical presentation and management of penetrating chest trauma

Thoracic injuries account for 20-25% of deaths due to trauma and contribute to 25-50% of the remaining deaths. Approximately 16,000 deaths per year in the United States alone are attributable to chest trauma. The present study was done in Dhaka Medical College Hospital from January 2004 to September 2005. This is one of the specialized Institutes of this country dealing with chest injury. In this series, 50 cases of penetrating chest injury were studied and 12 (Twelve) of them had also associated with blunt chest injury. The highest incidence occurred between the ages of 31 and 50 yrs. Male was predominantly affected by penetrating chest injury i.e. 84%. Homicidal injury was common in rural areas but accidental injury was common in urban area. Injuries by sharp weapon caused all of the homicidal injuries. In 28 cases (56%) showed penetrating chest injury with severe respiratory distress and rest 10 (20%) cases showed penetrating chest injury with hemorrhage from external wounds. Here, 70% cases are managed conservatively with or without I.C Tube drainage. Mean duration of Hospital stay for patient treated conservatively with or without 1C tube thoracostomy was 8 days but in patient with major surgery it was 15.5 days. Range of Hospital stay for conservatively treated patient was (3--8 days) and for patient with major surgery it was (10—16 days). Referred to other centers had due to extra--pulmonary Involvement, after initial resuscitation &amp; I.C. tube thoracostomy. Mortality:-2% for penetrating chest injury.

A rare case report of perforated viscerothorax in a traumatic diaphragmatic rupture

IntroductionDiaphragmatic injuries are a consequence of penetrating or blunt thoracoabdominal trauma. Minor injuries are often masked. However, they are easily picked in the presence of diaphragmatic herniations. Delayed presentation is associated with the influx of visceral contents into the thoracic cavity, which may cause strangulation and obstruction. Viscerothorax is a rare complication of diaphragmatic injuries.Presentation of caseA case report of a 25-year-old male patient with a history of penetrating chest injury. He presented to our setting with a sharp abdominal pain and episodes of vomiting that were later accompanied by chest pains and difficulty breathing. A CT scan revealed the presence of a left hemidiaphragmatic injury with a viscerothorax and mediastinal shift to the right side. Surgery was immediately done and with a good postoperative outcome.DiscussionDiaphragmatic injuries are still uncommon and are often overlooked in initial presentations. The presence of herniation through the defect prompts early diagnosis. Delayed presentations of these injuries are often affiliated with herniations that may be strangulating or obstructing with more severe complications such as viscerothorax causing tension into the thoracic cavity.ConclusionThe approach to diaphragmatic injuries at their initial presentation must be handled with an excellent index of suspicion in the evaluation of trauma victims to reduce management delay and avoid detrimental complications in contrast to the involvement of other associated injuries such as haemothorax, rib fractures, and visceral injuries. Early defect diagnosis followed by definitive surgical repair is the most favoured approach.

Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries

PurposeTo develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees’ performance for emergent and urgent thoracic surgeries. MethodsWith a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches. ResultsAnimal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury. ConclusionsAnimal model-based simulation training established in the current study could improve the trainees’ performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.