7 Peri-operative concerns in thoracic trauma

Hwang, Judith C.F.; Hanowell, Leland H.; Grande, Christopher M.

doi:10.1016/s0950-3501(96)80009-2

Cited by 8 publications

(7 citation statements)

References 75 publications

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“…Additionally, more than 90% of these patients will have associated injuries, half will require operation and intensive care unit admission, one-third will develop pulmonary complications and one-third will require discharge to an extended care facility [2]. The middle ribs are the ones most commonly fractured [3]. The first rib is rarely fractured because of its protected position behind the clavicle, so fractures of the first and second ribs usually signify severe trauma that can cause damage to the brachial plexus and subclavian vessels [4].…”

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confidence: 99%

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

Cho¹,

Sung²,

Kim³

2012

BJR

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Objective: The objective of this study was to review the prevalence and radiological features of rib fractures missed on initial chest CT evaluation, and to examine the diagnostic value of additional coronal images in a large series of trauma patients. Methods: 130 patients who presented to an emergency room for blunt chest trauma underwent multidetector row CT of the thorax within the first hour during their stay, and had follow-up CT or bone scans as diagnostic gold standards. Images were evaluated on two separate occasions: once with axial images and once with both axial and coronal images. The detection rates of missed rib fractures were compared between readings using a non-parametric method of clustered data. In the cases of missed rib fractures, the shapes, locations and associated fractures were evaluated. Results: 58 rib fractures were missed with axial images only and 52 were missed with both axial and coronal images (p50.088). The most common shape of missed rib fractures was buckled (56.9%), and the anterior arc (55.2%) was most commonly involved. 21 (36.2%) missed rib fractures had combined fractures on the same ribs, and 38 (65.5%) were accompanied by fracture on neighbouring ribs. Conclusion: Missed rib fractures are not uncommon, and radiologists should be familiar with buckle fractures, which are frequently missed. Additional coronal imagescan be helpful in the diagnosis of rib fractures that are not seen on axial images.

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confidence: 99%

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

Cho¹,

Sung²,

Kim³

2012

BJR

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“…Die Letalität Äl-terer mit stumpfem Thoraxtrauma liegt dennoch höher als bei penetrierenden Verletzungen, solange keine Herzverletzung vorliegt [40,63]. Ähnlich ist bei Kindern die Mortalität höher, wenn eine Herzbeteiligung vorhanden ist, allerdings unabhängig davon, ob es sich um stumpfe oder penetrierende Traumen handelt.…”

Section: E Auch Bei äUßerlich Fehlendenunclassified

“…Ähnlich ist bei Kindern die Mortalität höher, wenn eine Herzbeteiligung vorhanden ist, allerdings unabhängig davon, ob es sich um stumpfe oder penetrierende Traumen handelt. Zudem müssen Kinder nach penetrierenden Traumen häufiger aufgrund mediastinaler Komplikationen thorakotomiert werden [40,97]. …”

Section: E Auch Bei äUßerlich Fehlendenunclassified

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Emergency treatment of thoracic trauma

et al. 2006

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Thoracic trauma, most often associated with other serious injuries, is the main cause of death in the first 45 years of life. The percentage of chest injuries in multiple trauma, mainly from blunt impact, has remained relatively constant at 80% during the last 30 years. Isolated thoracic injuries comprise only 25% of all trauma cases, 90% of chest injuries are due to blunt impact, while penetrating injuries make up 5-10%. Since 25% of deaths from trauma are attributable to chest injuries, they determine the survival rate in multiple trauma to a significant extent. The pattern of chest injuries is variable, frequently in different combinations comprising rib cage and diaphragm, lung parenchyma, airway and mediastinal organs. This article details the immediate simultaneous diagnostic and therapeutic procedures in the prehospital phase, management in the emergency room, the relative importance of computed tomography, ultrasound examination and endoscopy in the primary diagnostic evaluation and the principles of anaesthetic management of thoracic trauma.

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“…TBI due to blunt trauma is considered to be caused by any combination of three possible mechanisms: an increase in pressure within the airways, shearing, and pulling apart. [4] Tracheal disruption is a rare occurrence and is seen in 14% of the penetrating neck and chest trauma cases and 0.34-1.5% of all blunt trauma cases including adults and children. [5] Lesions can be transverse occurring between the rings of the trachea, longitudinal, or spiral.…”

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confidence: 99%

Perioperative management of tracheobronchial injury following blunt trauma

et al. 2013

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We describe tracheobronchial injury (TBI) in a 17-year-old teenager following blunt trauma resulting from a road traffic accident. The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. Fiber-optic videobronchoscopy (FOB) was performed, the trachea and bronchi were visualized, and the site and extent of injury was assessed. Spontaneous respiration was maintained till assessment of the airway. Then the patient was anesthetized with propofol and paralyzed using succinylcholine and a double-lumen endobronchial tube was inserted; thereafter, the adequacy of controlled manual ventilation and air-leak through intercostal drains was assessed and the patient was transferred to operating room (OR) for repair of the airway injury. The OR was kept ready during FOB to manage any catastrophe. This case describes the need for proper preparation and communication between health care team members to manage all possible scenarios of traumatic TBI.

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7 Peri-operative concerns in thoracic trauma

Cited by 8 publications

References 75 publications

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT

Emergency treatment of thoracic trauma

Perioperative management of tracheobronchial injury following blunt trauma

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