Mediastinal impalement with a fibreglass sheet

Wimalachandra, Welege Samantha Buddhika; Asmat, Atasha

doi:10.11622/smedj.2014129

Cited by 2 publications

(5 citation statements)

References 2 publications

(1 reference statement)

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“…4, It is noteworthy, however, that diaphragmatic injury was present in 15.62% of patients, indicating abdominal injury. 2,9,12,16,26 In that group, all of the patients had intraabdominal organ injury (4 liver injuries, 1 splenic injury, and 2 hollow viscous injuries). Some studies described only the most significant injuries, whereas other studies did not describe the injuries, which may explain the low incidence of pulmonary lesions.…”

Section: Review Resultsmentioning

confidence: 97%

“…Regarding treatment, 21 patients underwent thoracotomy, and only 5 were unstable upon admission. [1][2][3][4][7][8][9][10][11][12][13]15,[19][20][21][22][23][24][25][26][27] Another therapeutic option carried out was removal of the impaled object under thoracoscopy (5 patients), 6,[14][15][16]18,24 and all of these patients were stable upon admission. Finally, 7 patients underwent direct removal of the penetrating object with thoracic drainage (1 patient being treated with the assistance of thoracoscopy on the right side and by direct removal on the left side).…”

Section: Review Resultsmentioning

confidence: 99%

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Object impaled in the Thorax: Review Study

Botelho-Filho¹,

Drumond²,

Starling³

et al. 2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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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.

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Section: Review Resultsmentioning

confidence: 97%

Section: Review Resultsmentioning

confidence: 99%

Object impaled in the Thorax: Review Study

Botelho-Filho¹,

Drumond²,

Starling³

et al. 2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

View full text Add to dashboard Cite

show abstract

“…6 Care of impalement injury patients begins in the pre-hospital setting. 2,3 Any foreign body should be left in place and great care should be taken to avoid manipulation of the object to limit further injury or exsanguination. 2,3 When patients arrive in the emergency department, we believe the trauma surgery service should be the first to evaluate the patient in accordance with Advanced Trauma Life Support protocols and then engage all appropriate specialties.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Any foreign body should be left in place and great care should be taken to avoid manipulation of the object to limit further injury or exsanguination. 2,3 When patients arrive in the emergency department, we believe the trauma surgery service should be the first to evaluate the patient in accordance with Advanced Trauma Life Support protocols and then engage all appropriate specialties. The reason for this is twofold: first, penetrating injuries may affect multiple organ systems for which the trauma surgeon is best-equipped to workup and prioritize therapies; second, the trauma team can then quickly involve consultants and initiate multidisciplinary discussion with regards to the appropriate surgical care of the injury.…”

Section: Discussionmentioning

confidence: 99%

“…Although past case reports have described isolated penetrating injuries to the spine and mediastinum, to our knowledge, there has never been a reported case of simultaneous mediastinal and spinal column glass injury. [2][3][4][5][6] This case presentation poses several unique management challenges in patients presenting with low-velocity penetrating injuries. We successfully managed this patient in multidisciplinary manner with planned diagnostic workup and sequenced surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

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