Treatment Of Thoracic Injuries Research Articles

Chinese expert consensus on echelons treatment of thoracic injury in modern warfare

The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People’s Liberation Army (PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level I facilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level II facilities. At Level III facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Prehospital Assessment and Treatment of Thoracic Injuries

This article was written for the proceedings from a conference entitled 12th Annual San Antonio Trauma Symposium in San Antonio, Texas. The opinions or assertions contained herein are the private views of the authors. San Antonio AirLife; email: [email protected].

Surgical Treatment for Thoracic Injuries - One Clinic's Experience

Surgical Treatment for Thoracic Injuries - One Clinic's Experience

Video-assisted thoracic surgery: clinical experience among 1264 patients

To summarize the clinical experience in video-assisted thoracic surgery (VATS). From December 1993 to December 2005 1264 patients, 894 males and 370 females, aged 38.9 +/- 12.0, underwent VATS, including bullectomy in 622 cases, resection of mediastinal tumor or cyst in 119 cases, resection of esophageal diseases in 107 cases, lobectomy or wedge-shaped lung resection in 215 cases, lung volume reduction surgery (LVRS) in 17 cases, treatment of thoracic injury in 28 cases, treatment of other thoracic diseases in 72 cases, and biopsy in 84 cases. For the resection of esophageal carcinoma VATS was conducted via the right approach, the esophagus was dissociated, the lymph nodes were resected, upper-abdominal incision was made, the stomach was dissociated and drawn up to the neck region, a cervical incision was made to anastomose the stomach and the residue of esophagus. Operation was completed by VATS successfully in 1230 patients, and 34 cases were converted to traditional thoracotomy because of thoracic adhesion or to radically treat the malignant tumors. Major complications occurred in 45 cases (3.56%), including air-leak lasting more than 7 days in 30 cases, post-operative bleeding in 4 cases (3 of which received VATS once more for hemostasis and the other underwent thoracotomy), hydrothorax or pneumothorax in 3 cases that underwent water-closed drainage, esophageal mucous rupture in 4 cases with achalasia and one case with leiomyoma, all of which underwent repair immediately, infection of pleural cavity in one case after the resection of esophageal diverticulum, and pneumonia in one case after LVRS. One patient with spontaneous pneumothorax and respiratory failure died 5 days after the bullectomy. Spontaneous pneumothorax occurred in 10 patients 2 months to 2 years after VATS 3 of which underwent bullectomy and pleurodesis by VATS once more. Spontaneous pneumothorax and some benign thoracic diseases are the major indications of VATS; however, great care should be expended to decide to treat malignant diseases by VATS. It is very important to train the surgeons who are to practice VATS. The practice of VATS should be individualized.

Appraisal of Early Evaluation of Blunt Chest Trauma: Development of a Standardized Scoring System for Initial Clinical Decision Making

Current techniques for assessment of chest trauma rely on clinical diagnoses or scoring systems. However, there is no generally accepted standard for early judgement of the severity of these injuries, especially in regards to related complications. This drawback may have a significant impact on the management of skeletal injuries, which are frequently associated with chest trauma. However, no convincing conclusions can be determined until standardization of the degrees of chest trauma is achieved. We investigated the role of early clinical and radiologic assessment techniques on outcome in patients with blunt multiple trauma and thoracic injuries and developed a new scoring system for early evaluation of chest trauma. A retrospective investigation was performed on the basis of 4,571 blunt polytrauma (Injury Severity Score [ISS] > or = 18) patients admitted to our unit. Inclusion criteria were treatment of thoracic injury that required intensive care therapy, initial Glasgow Coma Scale score greater than 8 points, and no local or systemic infection. Patients with thoracic trauma and multiple associated injuries (ISS > or = 18) were included. In all patients, the association between various parameters of the thoracic injuries and subsequent mortality and morbidity was investigated. A total of 1,495 patients fulfilled the inclusion criteria. Patients' medical records and chest radiographs were reevaluated between May 1, 1998, and June 1, 1999. The association between rib fractures and chest-related death was low (> three ribs unilateral, mortality 17.3%, odds ratio 1.01) unless bilateral involvement was present (> three ribs bilateral, mortality 40.9%, odds ratio 3.43). Injuries to the lung parenchyma, as determined by plain radiography, were associated with chest-related death, especially if the injuries were bilateral or associated with hemopneumothorax (lung contusion unilateral, mortality 25.2%, odds ratio 1.82; lung contusion bilateral + hemopneumothorax, mortality 53.3%, odds ratio 5.1). When plain anteroposterior chest radiographs were used, the diagnostic rate of rib fractures (< or = three ribs) increased slightly, from 77.1% to 97.3% during the first 24 hours of admission. In contrast, pulmonary contusions were often not diagnosed until 24 hours after admission (47.3% at admission, 92.4% at 24 h, p = 0.002). A new composite scoring system (thoracic trauma severity score) was developed that combines several variables: injuries to the chest wall, intrathoracic lesions, injuries involving the pleura, admission PaO2/FIO2 ratio, and patient age. The receiver operating characteristic curve demonstrated an adequate discrimination, as demonstrated by a value of 0.924 for the development set and 0.916 for the validation set. The score was also superior to the ISS (0.881) or the thorax Abbreviated Injury Score (0.693). Radiographically determined injuries to the lung parenchyma have a closer association with adverse outcome than chest-wall injuries but are often not diagnosed until 24 hours after injury. Therefore, clinical decision making, such as about the choice of surgery for long bone fractures, may be flawed if this information is used alone. A new thoracic trauma severity score may serve as an additional tool to improve the accuracy of the prediction of thoracic trauma-related complications.

Recent advances in the diagnosis and treatment of thoracic injury

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Preliminary report on videothoracoscopy in the evaluation and treatment of thoracic injury: Smith RS, Fry WR, Tsoi EK, et al. Am J Surg. 1993;166:690–695

Preliminary report on videothoracoscopy in the evaluation and treatment of thoracic injury: Smith RS, Fry WR, Tsoi EK, et al. Am J Surg. 1993;166:690–695

Preliminary report on videothoracoscopy in the evaluation and treatment of thoracic injury

A prospective trial of videothoracoscopy was conducted at an urban trauma center between February 1992 and February 1993 to determine the efficiency of this less invasive method of evaluation and treatment. Twenty-four consecutive patients with chest trauma (penetrating, n = 22; blunt, n = 2) were examined thoracoscopically for clotted hemothorax that otherwise would have been treated with thoracotomy (n = 9), suspected diaphragmatic injury (n = 10), and continued bleeding (n = 5). To ensure maximal exposure, general anesthesia with a double-lumen endotracheal tube was used in each patient. Clotted hemothorax was successfully evacuated in eight of nine patients (89%). Diaphragmatic laceration was suspected in 10 patients (2 abnormal chest radiographs, 8 proximity penetrating wounds) and confirmed thoracoscopically in 5. In four patients, diaphragmatic lacerations were successfully repaired with thoracoscopic techniques. Five patients underwent thoracoscopy for continued hemorrhage (greater than 1,500 mL per 24 hours) after tube thoracostomy. Intercostal artery injury was confirmed in all patients, and diathermy provided hemostasis in three patients without thoracotomy. No complications occurred. These data suggest the following: (1) Videothoracoscopy is an accurate, safe, and minimally invasive method for the assessment of diaphragmatic injuries, control of continued chest wall bleeding, and early evacuation of clotted hemothorax. (2) This technique should be used more frequently in patients with thoracic trauma. (3) Technical advances may expand the therapeutic role of thoracoscopy.

THORACIC TRAUMA IN CHILDREN

Thirty-seven children were admitted for the treatment of thoracic injuries during a 15-year period. Two thirds suffered blunt trauma. Of these children with blunt injuries, three quarters were male, with a median age of 6 years. Half of all victims of blunt trauma were between the ages of 4 and 6 years, and most were involved in motor vehicle crashes. Thirteen children (35%) were victims of penetrating trauma. Sixty-nine percent were male. The median age was 13 years, with 9 of 13 patients in their teenage years. Injuries were evenly distributed between stab and gunshot wounds. Eight of the 37 patients (22%) required thoracotomy. Fourteen had associated intra-abdominal injuries. Twelve of these patients had injuries that required exploratory laparotomy and two were managed expectantly. There were 27 patients with lung injuries, three quarters of whom were managed with tube thoracostomy alone. Seven children suffered injuries that resulted in their deaths. Six had been struck by a motor vehicle. Four of these six died of closed head injuries. The overall mortality of patients with blunt trauma was 25%. Language: en

The management of thoracic injuries.

WITH THE roads daily becoming choked with fast cars, Casualty Departments throughout the country are increasingly familiar with major chest injuries. The crushing forces applied to the chest as the driver is thrown against the steering column, and the stresses imposed upon mediastinal structures by rapid deceleration in head-on collision often produce injuries so severe that death is instantaneous. In those fortunate enough to reach hospital, resuscitative measures must be applied immediately and often by doctors untrained in thoracic surgery. London (1963) found ninetythree chest injuries in a series of 551 casualties admitted to the Birmingham Accident Hospital, and of these, sixty-eight had other important lesions. The principles underlying the management of thoracic trauma are straightforward and their application involves only a few easily acquired techniques. Abrams (1961a) succinctly defined the causes of death from chest injury as 'the lethal triad, bleeding, drowning and suffocation', and it is under these headings that the treatment of thoracic injuries will be considered.

Therapy of traumatic shock.

Article1 October 1951THERAPY OF TRAUMATIC SHOCKBENJAMIN BURBANK, M.D., F.A.C.P.BENJAMIN BURBANK, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-35-4-857 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe experiences of the past war have shown how very difficult it is to define by exact criteria just what constitutes the condition of shock. The end stage, in which the patient has no perceptible blood pressure or pulse, is pale with a gray cyanosis and cold with clammy perspiration, represents a medical defeat in diagnosis. Attempts to delineate a definite blood pressure level, such as 70 mm. Hg, have serious drawbacks because the end stage as described above may take place within a matter of minutes after such a reading. The same objections hold true for determining the...Bibliography1. Blalock A: Principles of surgical care; shock and other problems, 1940, C. V. Mosby Co., St. Louis. Google Scholar2. Moon VH: Shock and related capillary phenomena, 1938, Oxford University Press, New York. Google Scholar3. BurfordBurbank THB: Traumatic wet lung, J. Thoracic Surg. 14: 6 (Dec.) 1945. CrossrefGoogle Scholar4. BrewerBurbankSamsonSchiff LABPCCA: The wet lung in war casualties, Ann. Surg. 123: 343 (March), 1946. CrossrefGoogle Scholar5. JawetzSpeck ERS: Joint action of penicillin and chloramphenicol on an experimental streptococcic infection of mice, Proc. Soc. Exper. Biol. and Med. 74: 93-96, 1950. CrossrefMedlineGoogle Scholar6. Beecher HK: Morphine poisoning in battle casualties, Medical Bulletin, NATOUSA 1: 22 (Feb.) 1944. Google Scholar7. Dry J: Personal communication. Google Scholar8. FitzpatrickAdamsBurbank LJAJB: Nerve block in the treatment of thoracic injuries, Medical Bulletin, NATOUSA 2: 51-53 (Sept.) 1944. Google Scholar9. SamsonBrewerBurbank PCLAB: Tracheobronchial catheter aspiration, Bull. U. S. Army M. Dept. 5: 227 (Feb.) 1946. MedlineGoogle Scholar10. Hadfield G: Differential diagnosis of lung injuries, Lancet 2: 197-199 (Aug. 16) 1941. Google Scholar11. Zuckerman S: Discussion on problems of blast injuries, Proc. Roy. Soc. Med. 34: 171-192 (Jan. 6) 1941. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Brooklyn, New York*Received for publication February 7, 1951.From the Department of Medicine, State University Medical Center at New York, College of Medicine, and the Long Island College Hospital, Brooklyn, New York. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 October 1951Volume 35, Issue 4Page: 857-871KeywordsBlood pressureHeart rateHospital medicineShockSweat ePublished: 1 December 2008 Issue Published: 1 October 1951 PDF downloadLoading ...