Características clínicas y terapéuticas de pacientes con hemotórax traumático / Clinical and therapeutic characteristics of patients with traumatic hemothorax

Introducción: el hemotórax traumático constituye una enfermedad grave dentro de los traumas del tórax, con un número significativo de complicaciones. Objetivo: describir las características clínicas, epidemiológicas y quirúrgicas del hemotórax traumático. Métodos: se realizó un estudio descriptivo de una serie de casos, que incluyó a 236 pacientes con el diagnóstico de hemotórax traumático, atendidos en el servicio de Cirugía General del Hospital Provincial Saturnino Lora de Santiago de Cuba, desde enero de 2008 hasta diciembre de 2013. Fue aplicada la prueba chi cuadrado para identificar la asociación estadísticamente significativa entre variables de interés. Resultados: el sexo masculino predominó en los enfermos con una razón de 5 por 1 y la mayoría de ellos en edades comprendidas entre los 20 y los 39 años. La causa más frecuente de la lesión fue la herida por arma cortopunzante (62,3 por ciento), seguida de la contusión torácica (34,3 por ciento). El proceder quirúrgico más realizado fue la pleurotomía mínima (81,8 por ciento), el índice de complicación fue de 19,4 por ciento, predominando el hemotórax coagulado (23 pacientes). La mortalidad fue de un 3 por ciento. Conclusiones: el hemotórax traumático es característico de pacientes jóvenes en plena vida productiva. La pleurotomía mínima juega un rol básico en el tratamiento quirúrgico, excepto en los hemotórax medianos cuya cuantía sea cercana a los 1200 mL de sangre donde se recomienda evaluar la necesidad de toracotomía o videotoracoscopia según las condiciones del enfermo, con vista a disminuir complicaciones y mortalidad a causa de estas(AU)

Introduction: traumatic hemothorax is a serious disease in the group of thoracic traumas, with a significant number of complications. Objective: to describe the clinical, epidemiological and surgical characteristics of traumatic hemothorax. Method: a descriptive case-series study that included 236 patients with diagnosis of traumatic hemothorax, who went to the general surgery service of Saturnine Lora¨ Hospital of Santiago de Cuba from January 2008 to December 2013. The chi square test was applied to identify the statistically significant association among variables of interest. Results: males predominated at a ratio of 5 to 1 woman, most of them aged 20 to 39 years. The most frequent cause of the lesion was wound caused by sharp-edge weapons(62.3 percent), followed by the thoracic contusion (34.3 percent) and the most used surgical action was minimal pleurotomy (81.8 percent). The index of complication was 19.4 percent, mainly the coagulated hemothorax (23 patients). The mortality rate was 3 percent. Conclusions: traumatic hemothorax is common in young patients at full productive life. Minimal pleurotomy plays an important role in the surgical treatment, except for median hemotórax whose quantity is roughly 1200 ml of blood in which it is recommended to evaluate videoassisted thoracoscopy according to the patient´s health status, in order to decrease morbidity and mortality from these complications(AU)

Application of emergency thoracotomy in treatment of chest trauma / 重庆医学

Objective To discuss the application indications of emergency thoracotomy (ET) and the surgical strategy in the treatment of chest trauma .Methods The clinical data of 35 chest trauma patients treated by ET from January 2010 to March 2014 were analyzed retrospectively .Results In 35 cases ,the injury severity score (ISS) was 12-65 ,average 31 .63 .23 cases were pene‐trating injuries and 12 cases were blunt injuries .28 cases (80 .00% ) manifest as shock on admission .Blood loss in all cases was 1 000-5 000 mL ,average 2 400 mL and 20 cases were over 3 000 mL .ET was performed in the emergency room (6 cases) and the operative room (29 cases) .The time of admission to surgery in all cases was<30 min .12 cases (34 .29% ) died ,with average ISS score of 48 .26 .The main causes of death were cardiac tamponade and hemorrhagic shock .23 cases (65 .71% ) survived .The surviv‐al rates of penetrating and blunt injury were 78 .26% (18/23) and 41 .67% (5/12) respectively .The occurrence rate of complications in the survivals was 39 .13% (9/23) .Conclusion Massive bleeding ,ventilation dysfunction and cardiac tamponade caused by severe chest trauma are the important indications of ET ;the patient with chest penetrating injury on high‐risk positions should be actively performed the exploratory thoracotomy ;race against time rapid thoracotomy is the key for successful treatment .

Toracotomía de mmergencia en lesiones cardiacaspor arma blanca en el hospital clínico francisco viemma / Emergency toracothomy in cardiac injury in the Hospital Clinical Francisco Viedma

Las lesiones cardiacas se han descrito con mucha claridad en el transcurso de la historia. Existen descripciones de heridas penetrantes de tórax en el papiro de Smith que data de 3000 a. C. y en la Ilíada, siglo XIX a. C, que contiene referencias específicas del desangramiento como causa de muerte y de cuerpos extraños localizados dentro del corazón. Muchos de los pacientes con lesiones cardiacas mueren en el sitio de la agresión, durante el traslado o en la sala de emergencia y muchas de estas muertes se pueden prevenir con un transporte rápido asistido, realizando un diagnóstico y manejo hemodinámico precoz en sala de emergencia y realizando una TORACOTOMÍA INMEDIATA DE EMERGENCIA, ADECUADA, AMPLIA Y DE ABORDAJE RÁPIDO, con excelente exposición cardiaca y de sus grandes vasos. Presentamos tres casos de pacientes hospitalizados en el Hospital Clínico Viedma con lesiones penetrantes de corazón que fueron sometidos a Toracotomía de Emergencia, dos de los cuales simultáneamente presentaron traumas penetrantes de abdomen por arma blanca, el manejo a cargo de cirugía general de emergencia, los tres pacientes evolucionaron de manera favorable y fueron dados de alta en óptimas condiciones.

Cardiac lesions have been described very clearly in the course of history. There are descriptions of penetrating chest wounds in the Smith papyrus dating from 3000 B C. and in the Iliad, XIX century B C, which contains specific refer-ences to the bleeding as the cause of death of foreign bodies located within the heart. Many patients with cardiac injuries die at the site of the attack, during transport or in the emergency room and many of these deaths can be prevented by rapid transport assisted by an early diagnosis and hemodynamic management in emergency room mak-ing immediate emergency thoracotomy, RIGHT, LARGE AND RAPID APPROACH, with excellent exposure heart and its large vessels. The cardiac lesions appear to be the biggest challenge of trauma surgery. Its handling requires immediate surgery, an experienced surgeon who has good technique, and the ability to offer better recovery and post-operative lifestyle for the patient. We present three patients hospitalized at Hospital Viedma with heart penetrating injuries who underwent emergency thoracotomy, two of which presented simultaneously penetrating abdominal trauma stab in charge of handling emergency general surgery, three patients evolved favorably and were discharged in optimal conditions.

Hemothorax in an Uncontrolled Anticoagulated Patient: Fight or Flight?: A Case Report / 대한구급학회지

Hemothorax in a patient on anticoagulant therapy for atrial fibrillation after blunt trauma is not an uncommon event. However, massive hemothorax in such a patient with an extremely uncontrolled and high international normalized ratio (INR) may pose a serious dilemma. We report a case of a patient under anticoagulant therapy for atrial fibrillation who underwent an emergent thoracotomy for massive hemothorax with an INR of 9.57.