Thoracic trauma in military settings

Mansky, Robert; Scher, Corey S.

doi:10.1097/aco.0000000000000694

Cited by 9 publications

(1 citation statement)

References 84 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Major traumas in battlefields are caused by explosions and are associated with inhalation, burn and blast injuries. There are four major types of blast injuries: direct tissue damage from pressurized waves, secondary injuries from penetrating wounds from projectiles, tertiary injuries from blunt or penetrating trauma caused by blast winds, and quaternary injuries including burns, radiation, and inhalation injuries ( 81 ). Soldiers exposed to explosions are thus at risk for multiple trauma injuries, including pulmonary injury.…”

Section: Combat Injuriesmentioning

confidence: 99%

Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

Willers¹,

Mariani²,

Maessen³

et al. 2023

J Thorac Dis

View full text Add to dashboard Cite

Background and Objective: Resuscitative therapies for respiratory and cardiac failure are lifesaving and extended by using extracorporeal life support (ECLS) as mechanical circulatory support (MSC). This review informs the debate to identify the life-threatening thoracic emergencies in which patients may be cannulated for ECLS support.Methods: An advanced search was performed in PubMed, Embase, Google Scholar, and references query, assessed in June 2022, identified 761 records. Among them, 74 publications in English were included in the current narrative review.Key Content and Findings: ECLS is an additional tool for organ support in life-threatening thoracic emergencies. It provides bridging to recovery or to decision about destination as definitive therapy, intervention, or surgery. Non-traumatic emergencies include mediastinal mass, acute lung injury (ALI), aspiration, embolisms, acute and chronic heart failure. However, based on the current evidence, trauma, and especially blunt thoracic trauma, is one of the main indications for ECLS use in thoracic emergencies, among others in chest wall fractures, blunt and penetrating lung injuries. ECLS use is always individualized to patient's needs, injury pattern and kind of organ failure, circulatory arrest inclusive, depending on if respiratory or cardiac and circulatory support is needed. Further, ECLS offers the possibility for fast volume resuscitation and rewarming, thus preventing the lethal of trauma: hypothermia, hypoperfusion and acidosis. Anticoagulation may be omitted for some hours or days. Interdisciplinary cooperation between the intensivists, surgeons, anesthesiologists, emergency medical services, an appropriately organized and trained staff, equipment resources and logistical planning are essential for successful outcomes.Conclusions: ECLS use in selected life-threatening thoracic emergencies is increasing. The summarized findings appeal to policymakers, and we hope that our summary of recommendations may impact clinical practice and research.

show abstract

Section: Combat Injuriesmentioning

confidence: 99%

Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

Willers¹,

Mariani²,

Maessen³

et al. 2023

J Thorac Dis

View full text Add to dashboard Cite

show abstract

Ethical surgical triage of patients with head and neck cancer during the COVID‐19 pandemic

et al. 2020

View full text Add to dashboard Cite

Background: Coronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami Hospital System, COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended.Methods: An Otolaryngologic Triage Committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for nonsurgical options. Patients were tested twice for coronavirus before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible.Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made.Results: Hundreds of surgeries were canceled. Sixty-five cases screened over 3 weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of COVID-19 exposure tempered these discussions. Conclusions: We describe the use of actively managed surgical triage to fairly balance our patient's health with public health concerns.

show abstract