Cardiac trauma

Background: Surgical stabilization may provide an early restoration of chest wall contour and lead to decrease in the duration of ventilatory support. Long-term postoperative pulmonary function seems to be better preserved after surgical stabilization.Objective: To evaluate pulmonary function tests and oxygenation in patients with thoracic wall surgical stabilization for flail chest.Materials and methods: Forty patients (30 men, 10 women; mean age 42.6 years) with anterolateral flail chest (P4 ribs fractured at P2 sites) fulfilled the inclusion criteria and underwent surgical stabilization using metallic reconstruction plates under general anesthesia using lung protective ventilation strategy. Clinical assessment, pulmonary function testing and blood gas analysis were performed before surgery, and after 3 months following surgery. Ten patients could not perform pulmonary function because of either instability or non-cooperation.Results: Indications for surgical fixation were as follows: ten patients required thoracotomy because of associated thoracic injuries; fifteen non-intubated patients had antero-lateral flail chest; fifteen patients without pulmonary contusion presenting with impaired respiratory functions required early surgical stabilization.A satisfactory stabilization of the chest wall was obtained in all surgically treated patients. There were statistically significant differences in PaO2 (62.2 ± 8.3 and 97.6 ± 6.4), PaCo2 (38.1 ± 9.3 and 32.4 ± 8.4) and SpO2 (89.2% ± 1.4 and 98.4 ± 1.6) with a P value <0.001, respectively. Improvement of the pulmonary function test was significant in FVC (69.28 ± 5.9 and 78.55 ± 5.5), FEV1 (68.07 ± 4.7 and 78.97 ± 3.9) and PEF (72.68 ± 4.7 and 80.23 ± 4.1) with a P value 0.001. There was no 30-day and 3 month mortality for the surgically treated patients. The median intensive care unit stay was 4.5 days. Infectious complications occurred in 5% (2/40 patients).Conclusion: Surgical stabilization of flail chest with metallic plates is a safe and effective therapy in properly selected patients. These patients had a significantly smoother course during the intensive care unit and hospital stays, had improved respiratory functions and decreased rate of complications.

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“…This in accordance with our study as restoring hypoxemia was obtained in all our patients after surgical stabilization [19,20].…”

Section: Discussionsupporting

confidence: 92%

Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization

Moslam

Badawy

Asida

2015

Egyptian Journal of Chest Diseases and Tuberculosis

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“…In this case, the injury was to the pericardium. Had it been a myocardial penetration, it could have led to catastrophic haemodynamic instability from massive haemopericardium and tamponade physiology, which is commonly seen in these patients 3. Management of haemodynamically stable patients with penetrating chest wall injury comprises a chest X-ray, TTE and CT chest to rule out injury to the heart or other mediastinal structures 4…”

Section: Discussionmentioning

confidence: 99%

Nail to the heart: no big deal. A rare case of post-traumatic pericarditis

et al. 2018

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This is a unique case report of a 32-year-old man who presented with pneumatic nail gun injury to his right chest at work. He removed the nail and continued to work through the day. With continued chest pain, he presented to the emergency room and an echocardiogram revealed moderate-size pericardial effusion. He was managed conservatively as he was haemodynamically stable. Serial echocardiograms revealed slow resolution of the effusion over 3 days. At his 3-month follow-up appointment, there was complete resolution of his effusion. This case highlights the importance of obtaining imaging studies in penetrating chest wall injuries and utilisation of medications to prevent expected complications.

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“…The majority of patients with penetrating cardiac wounds present with signs of cardiac tamponade or massive bleeding and may die shortly after injury. The remaining patients can present with a conserved hemodynamic status (Symbas, 1976).…”

Section: Discussionmentioning

confidence: 99%