Emergency treatment of thoracic trauma

Klein, U.; Laubinger, R.; Malich, Ansgar; Hapich, Arno; Gunkel, W.

doi:10.1007/s00101-006-1092-6

Cited by 15 publications

(5 citation statements)

References 93 publications

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“…Before EGD and CT are being initiated, airway patency of the patient should be confirmed and monitored during the examination (pulseoximetry). EGD remains the diagnostic standard of injury classification after caustic ingestion [ 4 , 7 , 22 ]. It should be performed within 24 h after the injury and provides direct visualization of mucosal structures.…”

Section: Discussionmentioning

confidence: 99%

Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Struck

Beilicke

Hoffmeister

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundCaustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures.MethodsWe retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality.ResultsTwenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3 (21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality.ConclusionsCaustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.

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Section: Discussionmentioning

confidence: 99%

Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Struck

Beilicke

Hoffmeister

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Under these conditions, the posttraumatic course and outcome are significantly influenced by thoracic injuries, which can account for up to 25% of trauma-related deaths34. Therefore, chest trauma represents a leading cause of adverse outcome after multiple trauma5678.…”

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confidence: 99%

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Horst

Simon

Pfeifer

et al. 2016

Sci Rep

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Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics.

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“…Zusätzlich sind 3310 an einem Polytrauma Verstorbene registriert, 2294 Männer und 1016 Frauen [1]. Etwa 80 % der Polytraumata sind mit einem Thoraxtrauma assoziiert [2]. In Industrienationen ist in der Altersgruppe der 5-bis 44-Jährigen ein Unfall die Haupttodesursache mit steigender Inzidenz [3].…”

Section: Epidemiologieunclassified

“…Bei der Beatmung der bereits geschädigten Lunge sollten hohe Beatmungsdrücke und inspiratorische Sauerstoffkonzentrationen > 80 % vermieden werden zur Prophylaxe eines zusätzlichen Barotraumas oder Atelektasenbildung. Ein PEEP von 6-8 cmH 2 O ist sinnvoll [2].…”

Section: Sicherung Der Atemwege Volumentherapie Und Notfallnarkoseunclassified

Der Patient mit Thoraxtrauma: präklinische Versorgung

Hansen¹,

Hachenberg²

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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Penetrating thoracic injuries are rare in Germany and common in urban regions. 10 percent of the patients in Emergency Departments suffer from blunt thoracic trauma. Mechanism of trauma can predict the severity of the injuries. Very fast life-threatening injuries with hemodynamic problems like tension pneumothorax or cardiac tamponade have to be diagnosed. Prehospital emergency physicians need skills in ultrasound for diagnosis and in invasive therapy like chest tube or pericardium drainage tube. The application of an algorithm in exploration of a thoracic trauma seems to be useful. The selection of trauma center depends on the severity of the trauma, if necessary with the availability of extracorporeal circulation.

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Emergency treatment of thoracic trauma

Cited by 15 publications

References 93 publications

Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Der Patient mit Thoraxtrauma: präklinische Versorgung

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