Treatment Of Chest Injuries Research Articles

Эволюция стратегии и тактики хирургического лечения повреждений груди

Эволюция стратегии и тактики хирургического лечения повреждений груди

Current concepts in rib fracture fixation

Rib fracture fixation by orthopaedic and cardiothoracic surgeons has become increasingly popular for the treatment of chest injuries in trauma. The literature, though mainly limited to Level II and III evidence, shows favourable results for operative fixation. In this paper we review the literature and discuss the indications for rib fracture fixation, surgical approaches, choice of implants and the future direction for management. With the advent of NICE guidance and new British Orthopaedic Association Standards for Trauma (BOAST) guidelines in production, the management of rib fractures is going to become more and more commonplace.

Diagnosis and Treatment of Chest Injury and Emergency Diseases of Chest Organs

Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs. Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1%) victims. There were 477 (22,6%) patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu# mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3%) patients and complicated forms of lung echinococcosis were evident in 72 patients. Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1%) patients, whereas the traditional methods were effective only in 905 cases (42,9%). Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

Small Catheter Tube Thoracostomy: Effective in Managing Chest Trauma in Stable Patients

Image-guided small catheter tube thoracostomy (SCTT) is not currently used as a first-line procedure in the management of patients with chest trauma. We adopted a practice recommendation to use SCTT as a less invasive alternative in the treatment of chest injuries. We reviewed our trauma registry to evaluate our change in practice and the effectiveness of SCTT. Retrospective review of all tube thoracostomies (TT) performed in patients with chest injury at a level I trauma center from September 2002 through March 2006. Data collected included age, sex, indications and timing for TT, use of antibiotics, length of stay, complications, and outcomes. Large catheter tube thoracostomy (LCTT) not performed in the operating room or trauma room and all SCTT were deemed nonemergent. There were 565 TT performed in 359 patients. Emergent TT was performed in 252 (70%) and nonemergent TT in 157 (44%) patients, of which 63 (40%) received LCTT and 107 (68%) received SCTT. Although SCTT was performed later after injury than nonemergent LCTT (5.5 days vs. 2.3 days, p < 0.001), average duration of SCTT was shorter (5.5 days vs. 7 days, p < 0.05). Rates of hemothoraces were similarly low for SCTT versus nonemergent LCTT (6.1% vs. 4.2%, p = NS) and rates of residual/recurrent pneumothoraces were not significantly different (8% vs. 14%, p = NS). The rate of occurrence of fibrothorax, however, was significantly lower for SCTT compared with nonemergent LCTT (0% vs. 4.2%, p < 0.05). In patients receiving a single nonemergent TT, SCTT was performed in 55 (61%) and LCTT in 35 (39%). A comparison of these groups revealed that SCTT was performed in older patients (p < 0.05), and was associated with a lower Injury Severity Score (p < 0.05) and shorter length of stay (p = 0.05). SCTT was increasingly used in younger and more seriously injured patients as our experience grew. SCTT is effective in managing chest trauma. It is comparable with LCTT in stable trauma patients. This study supports adopting image-guided small catheter techniques in the management of chest trauma in stable patients.

Chest Injury in Children in Amman – Jordan

This is a retrospective study of 42 children admitted for treatment of chest injuries during a 5-years period (1990 – 1995) at King Hussein Medical Center, Amman – Jordan. Types of injury, age group, and sex incidence were recorded. Thirty children (71.5%) suffered blunt chest trauma. Twenty-seven (64%) were boys while fifteen (36%) were girls. Mean age was 10 years (1-14 years). The majority were involved in vehicular-pedestrian and road traffic accidents. Twelve (28.5%) were victims of penetrating injuries. Five cases required thoracotomy, four cases required lapatotomy and thoracotomy and nine patients (21%) died. Routine use of third generation cephalosporins was effective, steroids were not used routinely. Epinephrine and bronchodilators nebulizers were used routinely specially post extubation. Chest injuries in children are increasing and is a cause of significant mortality. Chest injuries are common in our country, specially in school age group. Public awareness is mandatory to reduce the incidence of these injuries Key Words: chest injuries, penetrating and blunt injury, children. Mary Slessor Journal of Medicine Vol.4(1) 2004: 72-75

Chest Injuries: Physiologic Principles and Emergency Management

This lucid presentation of the pathophysiology, diagnosis, and treatment of chest injuries is entirely clinical in approach, by an author who has treated more than 5,000 chest-injured patients. While he provides a bibliography, he does not in the text refer to these papers. Instead, to stress an important principle, he draws on his experience or uses cases representing an error in management. For example, a patient died, expectorating and drowning in blood thought secondary to bullet wounds of the chest and head. At necroscopy, the nasopharynx was found to be the only bleeding source. Conclusion: Simple postnasal packing would have averted death. The reader is first exposed to several excellent color illustrations by Frank Netter. A clear, practical discussion of all pertinent basic sciences follows, aimed primarily at the medical student. Standard bedside procedures such as nasotracheal suction or intercostal drainage techniques are then explained. A lengthy section on problems

Practical points in the treatment of chest injuries.

AnaesthesiaVolume 22, Issue 3 p. 392-399 Free Access Practical points in the treatment of chest injuries* J. A. COLLIE M. Med. (Cape Town), ffarcs, J. A. COLLIE M. Med. (Cape Town), ffarcs Nuffield Department of Anæsthetics Radcliffe Infirmary, Oxford 31 (A) Davey Street, Frankston, Victoria, AustraliaSearch for more papers by this authorJ. w. LLOYD ffarcs , J. w. LLOYD ffarcs Nuffield Department of Anæsthetics Radcliffe Infirmary, OxfordSearch for more papers by this author J. A. COLLIE M. Med. (Cape Town), ffarcs, J. A. COLLIE M. Med. (Cape Town), ffarcs Nuffield Department of Anæsthetics Radcliffe Infirmary, Oxford 31 (A) Davey Street, Frankston, Victoria, AustraliaSearch for more papers by this authorJ. w. LLOYD ffarcs , J. w. LLOYD ffarcs Nuffield Department of Anæsthetics Radcliffe Infirmary, OxfordSearch for more papers by this author First published: July 1967 https://doi.org/10.1111/j.1365-2044.1967.tb02761.xCitations: 2 * Paper presented at the Annual Meeting of the Association of Anæsthetists, 10–11 November 1966 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 LLOYD, J.W., SMITH, A.C, and CONNOR, B.T. (1965). Classification of chest injuries as an aid to treatment. Br. med. J., i, 1518. 2 SIMPSSON, B.R., LAMBRECTS, W., MARSHALL, R. and PARKHOUSE, J. (1961). Extradural analgesia and the prevention of postoperative respiratory complications. Br. J. Anaesth., 33, 628. 3 SMITH, A.C., SPALDING, J.M.K. and WATSON, W.E. (1962). CO2 as Stimulus to spontaneous ventilation after prolonged artificial ventilation J. Physiol., 160, 32. 4 SALT, R.H. and AGERHOLM, M. (1965). Tracheostomy adapters for patients with severe respiratory paralysis who depend on intermittent positive-pressure respiration. Lancet, i, 468. 5 SPALDING, J.M.K. (1956). Humidifier for patients breathing spontaneously. Lancet, ii, 1140. 6 ROBINSON, J.S. ( personal communication). Citing Literature Volume22, Issue3July 1967Pages 392-399 ReferencesRelatedInformation

Treatment of chest injuries

The two principal specific requirements in therapy of chest injuries are to enable the patient to breathe and to cough effectively. The therapeutic measures required range from such simple methods as intercostal nerve blocks, the application of sandbags to the chest wall and the humidification of inspired air, to endotracheal suction, tracheotomy and ventilation with a mechanical respirator. Shock from hemorrhage must be treated vigorously with whole blood. A hypotension which does not respond is often owing to respiratory acidosis from inadequate ventilation, a tension pneumothorax or cardiac tamponade. Once the ability of the patient to breathe and to cough has been restored, the main principle of therapy is expansion of the lung by the complete removal of air and fluid from the pleural cavity. This may be accomplished either with serial thoracenteses or with an intercostal tube. Thoracotomy is required in only a small percentage of chest injuries, usually for continued hemorrhage or for injury of the mediastinal or subdiaphragmatic viscera.

The Avoidance of Complications in the Treatment of Chest Injuries

The Avoidance of Complications in the Treatment of Chest Injuries

Management of chest injuries.

Wars accelerate interest and experience in the treatment of injuries; however, with the cessation of hostilities, interest lags, in spite of numerous civilian injuries incurred in automobile and industrial accidents. The experiences in World War II revolutionized the treatment of chest injuries: techniques were improved, the physiology of the thorax was better understood, and trained surgical teams were able to handle chest injuries rapidly and efficiently. Even with the extensive information on this subject, there is little specific information for training emergency teams in the proper handling of patients with chest injuries before they come into the hands of a trained surgeon. In this article, we have enumerated the specific treatments for patients with chest injuries from the time they are placed in the ambulance until the treatment is concluded. EMERGENCY TREATMENT Emergency Treatment in the Ambulance.— Emergency treatment should start in the ambulance. Persons injured in isolated areas often

Chest injuries in civilian practice.

Current practices in the treatment of chest injuries encountered in civilian practice are discussed with some consideration given their physiologic rationale. Penetrating injuries of the chest wall and lungs, with and without sucking wounds, are discussed in some detail in regard to their emergency treatment and follow-up care. Crushing injuries to the chest wall, with and without paradoxical motion, are described, together with their potential complications and management. Detection and treatment of the contused heart, and the heart with a penetrating wound are described. General consideration of complicating pneumonia, atelectasis, ileus, diaphragmatic hernia, hemothorax and other complications is given. Recommendations are made in regard to the use of intercostal nerve block for the relief of pain, methods of oxygen administration, and the use of x-ray assistance in the management of all types of chest injuries.

Chest Manifestations in Abdomino-thoracic Injuries

There appear to be two distinct stages in the treatment of chest injuries. The first stage is that in which operative interference is concerned with actively saving life, and the second where the object of treatment is to reduce the subsequent permanent damage to a minimum. Both these stages present their own radiological problems. It is evident that in the first stage of the injury there are many conditions which are so urgent, and the clinical diagnosis so frequently obvious, e.g., large sucking wounds, acute cardiac tamponade, and paradoxical respiration following multiple fractures of the ribs, that radiological examination is not required, and in fact not desirable, but there are certain conditions which can be recognised radiologically, and their recognition will considerably help the clinicians. These are:— 1. Tension pneumothorax. 2. Intrapleural hæmorrhage. 3. Traumatic diaphragmatic hernia. 4. Blast injuries. 5. The recognition of the presence of foreign bodies. 1. Tension pneumothorax (Fig. 1). The appearances of this condition are so well known that it is hardly necessary to enumerate the different points: the markedly collapsed lung, the mediastinum displaced away from the lesion, and the depressed diaphragm on the same side as the lesion. 2. Intrapleural hæmorrhage. The formation of effusion soon after a chest injury, particularly one which increases rapidly in amount, should suggest the possibility of intrapleural hæmorrhage.

Discussions on the Function of the Radiologist in the Diagnosis and Treatment of Chest Injuries

Discussions on the Function of the Radiologist in the Diagnosis and Treatment of Chest Injuries

Recent experience with war wounds of the chest

D URING the Iatter part of the Iast war, much interest became focused on wounds of the chest owing to the new conception that thoracic injuries shouId be treated on the same principIes as wounds eIsewhere in the body. The conclusions reached as a result of this fresh outIook have been fuIIy described (DuvaI,’ GrCgoire and Courcoux,2 Gask,3 etc.). During the subsequent years of peace, steady progress was made in thoracic surgery. It is, therefore, important that we consider in what way this advance has inff uenced the treatment of chest casuaIties since the disastrous outbreak of further hostiIities. The preIude to the present vast conAagration occurred in Spain and those responsibIe for the care of chest wounds in the war of 1939 naturally sought the experiences of the surgeons who treated the Spanish casuaIties. JoIIy4 Ieaves the impression that few primary intrathoracic operations were performed for he states that “the outlook for a11 cases requiring an intrathoracic operation is grave” and “a Iung abscess deveIoping Iater in a Iiving man is to be preferred to an aseptic thoracic cavity in a dead one.” In generaI, JoIIy recommends the conservative treatment in vogue during the earIy phases of the 1914 war. It appears, therefore, that no advance in the care of thoracic wounds evoIved from the Spanish Civil War. AIthough a considerabIe amount has been written on chest wounds since the outbreak of the present War, most of the opinions expressed are based on experiences of over twenty years ago (Tudor Edwards,” etc.). This is partIy due to the fact that miIitary casuaIties have been mercifuIIy few and that chest wounds in civiIians resuIting from aeria1 bombardment tend to be severe and often resuIt in death before reaching the hospita1. Compared, therefore, with the aImost astronomic number of casuaIties deaIt with in the Great War, the experience derived during the Iast two years has been very Iimited. However, it is not proposed in this communication to re-state the generaIIy recognised features of war wounds of the chest but to consider any new factors which have arisen and to what extent the Iast two years have modified or confirmed the 1920 conceptions. Personnel. If DuvaI’s resuIts with thoracic wounds are compared with those obtained in the latter part of the Iast war from Iarge sections of the British Army (figures quoted by Gask3), it seems at first doubtfu1 if the genera1 adoption of DuvaI’s poIicy of frequent earIy surgical intervention in penetrating wounds was justified. There are many factors which influence individual group resuIts, in particular the nature of the missiles being used and the condition of the soil and men’s clothes. But, after adequate aIIowance has been made for these factors, there remains a discrepancy in resuIts which is at first confusing. This discrepancy is readiIy explained by the fact that there are very Iarge numbers of genera1 surgeons with exceIIent training but Iess than 5 per cent are accustomed to thoracic work. It wouId be futiIe to pass comment on this fact if it did not have a direct practica1 bearing on the treatment of chest injuries. Apart from the obvious concIusion that war caIIs for a higher percentage of thoracic surgeons and that those existent shouId be organized into readiIy avaiIabIe teams, it must aIso be cIear that the treatment of many individua1 cases must depend upon the thoracic training of the surgeon and, in addition, upon the