NOM of the penetrating right thoracoabdominal injuries must be seen with caution. The NOM of right thoracoabdominal gunshot injuries is safe only in selected cases, followed by well-defined protocols and when performed in places that have adequate infrastructure.
Objective:to evaluate the safety and effectiveness of non-operative management (NOM) of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6%) had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2%) were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%). Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.
Aim The aim of this study is to describe the management of a patient who presents with a penetrating chest trauma due to impalement by an offending object, be it a knife, metal structure, or other type of object. Background Until today, many institutions have treated this type of injury with urgent thoracotomy, despite advances in thoracoscopy and radiologic studies. A review was performed principally to discuss the use of nonoperative treatment, thoracoscopy, and thoracotomy. Thirty-two patients described as case reports in 27 articles were reviewed to carry out this descriptive study. For each patient, the following variables were studied: Age, gender, trauma mechanism, hemodynamic stability upon admission, treatment type, injuries encountered and associated with the condition, complications, and the final disposition of death vs survival. Review results Twenty-one patients were treated with thoracotomy or sternotomy, seven patients with removal of the impaling object without surgery, and five patients with removal of the object using thoracoscopic assistance (one patient was treated with the assistance of thoracoscopy on the right side and with direct removal on the left side). A summary of the evidence reviewed is provided in a flowchart. Conclusion With technological advancements, especially in thoracoscopy and computed tomography, many of these injuries are responsive to less invasive treatment. Thoracotomy, considered the standard of care in many trauma centers, can be reserved for specific cases. Clinical significance Pursuant to some of the criteria listed in this study, as occurs in our institution, the thoracotomy rate can be reduced, thereby reducing mortality and benefiting patients. How to cite this article Botelho-Filho F, Drumond DAF, Starling SV, Peixoto LC, Zille DP, Constantino GDC. Object impaled in the Thorax: Review Study. Panam J Trauma Crit Care Emerg Surg 2016;5(3):148-154.
Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
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