Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed.
INTRODUCTION/HYPOTHESIS:The current standard venous thromboembolism (VTE) chemoprophylaxis dose for trauma patients is inadequate at providing sufficient protection against the formation of deep vein thrombosis and pulmonary embolism. Anti-factor Xa-guided enoxaparin dosing has successfully decreased the occurrence of VTE in trauma patients at several institutions. The purpose of this systematic review is to present the current literature on anti-factor Xa-guided enoxaparin dosing approaches for VTE chemoprophylaxis and also to present the association between anti-factor Xa levels with the occurrence of VTE in a concise and organized manner.
METHODS:Four electronic databases, PubMed, EMBASE, JAMA network, and CINAHL Complete, were searched for articles regarding anti-factor Xa-guided enoxaparin dosing approaches and VTE chemoprophylaxis in the trauma patient population. The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The quality of evidence was assessed using the GRADE Working Group criteria.
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