Thoracic impalement injuries

Darbari, Anshuman; Tandon, S. K.; Singh, Arun K.

doi:10.1007/s12055-005-0057-8

Cited by 18 publications

(41 citation statements)

References 4 publications

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“…[12] Thoracic impalement accidents on the right side are more frequently encountered because on the left side the presence of the heart makes survival exceptional, with few survivals cases reported in the literature. [1,4,5,7,8,[13][14][15] If the patient survives, this is because the foreign object missed vital internal structures, especially the great vessels or heart. [4,15] This was also the case of our patient in whom vital structures were spared by the injury.…”

Section: Discussionmentioning

confidence: 99%

“…[16] Special attention must be paid to the injured region, and by all means the impalement object must not be mobilized or removed. [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16] All authors recognize the tamponade effect of the impaling object. Any dislodgement of the impaling object in the field may result in cataclysmic hemorrhage impossible to control.…”

Section: Discussionmentioning

confidence: 99%

“…The literature presents only few survival cases, the vast majority being unfortunately fatal. [1][2][3][4][5][6][7][8] One important issue for patient survival is rapid transportation of the victim to the appropriate hospital. A rapid and prompt reaction of the trauma team and adherence to a structured management protocol are also essential.…”

Section: Introductionmentioning

confidence: 99%

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Severe thoracic impalement injury: survival in a case with delayed surgical definitive care

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Moroşanu

Alexa

et al. 2015

Ulus Travma Acil Cerrahi Derg

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Impalement injuries are rare and among the most spectacular and dramatic traumatic lesions. The survival of a patient with a thoracic impalement injury is an extremely rare event. The objective of this study was to present the case of a 24-year-old male patient with a severe thoracic impalement injury successfully treated despite his late arrival in our hospital. A log in 12 cm diameter penetrated his right thorax producing injuries of the right main bronchus, right pulmonary lobe, right subclavian artery as well as extensive parietal lesions. Definitive surgical repair of these lesions was performed more than seven hours after trauma. The management principles contributing to the successful outcome that we would like to emphasize are: rapid transportation and reaction of the trauma team, minimal manipulation of the impaling object, removal of the log as one piece under direct vision in the operating room, ventilatory support, extensive debridement, and lavage associated with appropriate antibiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe thoracic impalement injury: survival in a case with delayed surgical definitive care

Luncă

Moroşanu

Alexa

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…4 Efforts at removal are best carried out under direct vision in a controlled environment as obtains in an operating theatre. 5 Premature removal may result in exsanguinating haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Impalement injuries of the chest

Edwin

Tettey²,

Sereboe³

et al. 2010

Ghana Medical Journal

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SUMMARYImpalement injuries of the chest are uncommon in civilian practice with few reports in the literature. We report three cases of thoracic impalement seen over a 5 year period with unusual underlying mechanisms. In two of the cases, the impalement was obvious; in the third, the impalement was concealed having occurred 5 months earlier. In Case 1, the underlying mechanism was a high-speed road traffic accident. The patient was impaled by a metallic square pipe piled by the roadside. In Case 2, the gun-housing of a locally-made rifle gave way as it was fired and allowed a reverse ejection of the barrel during recoil that impaled the hunter's chest. In Case 3, a domestic assault with an old umbrella caused an impalement injury as one of the umbrella spokes broke off, penetrated and lodged in the left chest going unnoticed for 5 months. Persistent chest pain and haemoptysis led to a request for chest radiographic examination upon which the foreign body was discovered. Massive haemoptysis brought the patient to emergency thoracotomy. All three patients underwent thoracotomy with a successful outcome.Keywords: Impalement injuries, thoracic, mechanisms, debridement, management. CASE REPORTSCase 1 A 22 year-old lady was referred to the National Cardiothoracic Centre (NCTC) with an impalement injury of the left upper chest following a road-traffic accident that morning as a passenger. When the van in which she was travelling skidded off the road, she got impaled on a metallic pipe piled by the roadside. She had chest pain and dyspnoea on admission. Examination showed a metallic square pipe lodged in the left chest in through-and-through fashion antero-posteriorly (Figure 1). She was conscious, alert and haemodynamically stable with a blood pressure of 110/80mmHg and a pulse of 104/minute. Respiratory examination showed signs of a left haemopneumothorax and left lung collapse. Apart from a laceration of the right arm and forearm the rest of the physical examination was normal. A left chest tube was inserted and preparations were made for thoracotomy. Broad-spectrum antibiotic prophylaxis (1 gram ceftriazone and 500mg metronidazole) and tetanus immunoglobulin were administered prior to surgery. Figure 1 Case 1 with impaled metallic objectAt surgery, the foreign body was extracted carefully without sequelae. There was a laceration of the left upper lobe; no major vessel or cardiac injury was found. The injured part of the left lung was debrided and the resulting defect repaired. Debridement of the chest wall at the entry and exit wounds was carried out. The pleural cavity and chest wall wounds were copiously lavaged with saline, a chest tube was passed and the incisions closed primarily. The patient was returned to the Intensive Care Unit. She made an uneventful recovery and was discharged on the 14 th post-operative day.

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“…Son múltiples los mecanismos productores y la ingesta de alcohol y drogas juega un importante papel en su génesis. Existen reportes en la literatura de diversos sitios anatómicos de empalamiento: torácicos [4][5][6] , inguinales 7 , abdominales [1][2][3] , y otros. Según Eachempati 4 , las lesiones por empalamiento pueden ser subdivididas en 2 grupos.…”

Section: Discussionunclassified

Empalamiento tóraco-abdominal: Reporte de un caso

G¹,

H²,

P³

et al. 2009

Rev Chil Cir

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Impalement involving abdomen and thorax. Report of one caseImpalements, especially those involving more than one anatomical region, are uncommon. We report a 30 years old male that was injured by a steel jimmy bar that entered by the left inguinal region and exited by the posterior part of the left hemithorax, causing multiple intestinal lesions, a lung and diaphragmatic lesion, costal and scapular fractures. He was operated, extracting the jimmy bar and correcting the multiple lesions. He was discharged ten days later.Key words: Impalement, jimmy bar. ResumenLos casos de empalamiento son altamente infrecuentes, sobre todo aquellos que comprometen más de una región anatómica. Damos a conocer el caso de un obrero de 30 años que accidentalmente fue transfixiado por un chuzo, con entrada a nivel inguinal izquierdo y salida por hemitórax ipsilateral, lo que ocasionó múltiples lesiones intestinales, lesión diafragmática, lesión pulmonar y fracturas expuestas costales y escapular izquierda. Su evolución fue exitosa debido a un adecuado manejo pre e intrahospitalario.Palabras clave: Empalamiento tóraco-abdominal. IntroducciónSe entiende como herida por empalamiento a toda herida penetrante causada por un objeto inciso-punzante, de forma que el objeto vulnerante queda incorporado en el cuerpo del sujeto 1,2 . El empalamiento es un evento espectacular cuyo tratamiento exitoso depende de un manejo precoz y bien estructurado, tanto en la etapa prehospitalaria como intrahospitalaria 2,3 . El término "Empalamiento" fue originalmente popularizado en la época medieval, haciendo referencia al particular método por el cual las víctimas eran torturadas y asesinadas. El más famoso ejecutor de empalamientos fue el 15º príncipe de Rumania Vlad Tepes, conocido como "Vlad el Empalador", o también entre sus contemporáneos como "Drácula" o "El hijo del Dragón" 4 . CASOS CLÍNICOS

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Thoracic impalement injuries

Cited by 18 publications

References 4 publications

Severe thoracic impalement injury: survival in a case with delayed surgical definitive care

Severe thoracic impalement injury: survival in a case with delayed surgical definitive care

Impalement injuries of the chest

Empalamiento tóraco-abdominal: Reporte de un caso

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