Trauma cerrado de aorta torácica, desde el servicio de urgencias hasta el quirófano: revisión narrativa / Blunt trauma of the thoracic aorta, from the emergency department to the operating room: narrative review / Trauma contuso da aorta torácica: do pronto-socorro ao centro cirúrgico, uma revisão narrativa

El trauma es la principal causa de muerte de la población en edad productiva. El abordaje del trauma torácico cerrado todavía es un desafío para el médico de urgencias. Aunque no es una entidad frecuente, se asocia con una alta mortalidad y resultados adversos. El diagnóstico del trauma cerrado de aorta torácica (LCAT) requiere un alto índice de sospecha, dado que los signos y síntomas no son específicos de esta enfermedad (dolor torácico, dolor interescapular, disnea, disfagia, estridor, disfonía). Es importante resaltar que la ausencia de inestabilidad hemodinámica no debe descartar una lesión aórtica. Para su diagnóstico imagenológico se debe tener en cuenta que los rayos X de tórax no tienen el rendimiento adecuado, el patrón de referencia es la angiotomografía y el ecocardiograma transesofágico (ETE) constituye una opción diagnóstica. El manejo incluye líquidos endovenosos y antihipertensivos como medida transitoria, manejo quirúrgico definitivo y, en algunos casos, manejo expectante o diferido. Los pacientes inestables o con signos de ruptura inminente deben ser llevados de manera inmediata a cirugía. El manejo quirúrgico temprano ha impactado en la mortalidad. A pesar de los avances en las técnicas quirúrgicas, la técnica quirúrgica abierta documenta mayor tasa de mortalidad que el manejo endovascular, el cual tiene numerosas ventajas al ser poco invasivo. Esta es una revisión narrativa que destaca algunos aspectos clave sobre los mecanismos de lesión, diagnóstico y manejo inicial del trauma cerrado aorta torácica. Por último, se propone un algoritmo de abordaje de trauma de aorta.

Trauma is the leading cause of death in the productive-age population. Addressing blunt chest trauma is still a challenge for the emergency physician. Although it is not a common entity, it is associated with high mortality and adverse outcomes. The diagnosis of blunt thoracic aortic trauma (LCAT) requires a high index of suspicion, given that the signs and symptoms are not specific to this disease (chest pain, interscapular pain, dyspnea, dysphagia, stridor, dysphonia). It is important to highlight that the absence of hemodynamic instability should not rule out aortic injury. For its imaging diagnosis, it must be taken into account that chest X-rays do not have adequate performance; the reference standard is angiotomography and transesophageal echocardiography (TEE) is a diagnostic option. Management includes intravenous fluids and antihypertensives as a temporary measure, definitive surgical management and, in some cases, expectant or deferred management. Unstable patients or patients with signs of imminent ruptura should be taken immediately to surgery. Early surgical management has impacted mortality. Despite advances in surgical techniques, the open surgical technique documents a higher mortality rate than endovascular management, which has numerous advantages as it is minimally invasive. This is a narrative review that highlights some key aspects about the mechanisms of injury, diagnosis and initial management of blunt thoracic aortic trauma. Finally, an algorithm for addressing aortic trauma is proposed.

O trauma é a principal causa de morte na população em idade produtiva. Abordar o trauma torácico contuso ainda é um desafio para o médico emergencista. Embora não seja uma entidade comum, está associada a alta mortalidade e resultados adversos. O diagnóstico de trauma fechado de aorta torácica (TACE) requer alto índice de suspeição, visto que os sinais e sintomas não são específicos desta doença (dor torácica, dor interescapular, dispneia, disfagia, estridor, disfonia). É importante ressaltar que a ausência de instabilidade hemodinâmica não deve descartar lesão aórtica. Para seu diagnóstico por imagem deve-se levar em consideração que a radiografia de tórax não apresenta desempenho adequado; o padrão de referência é a angiotomografia e a ecocardiografia transesofágica (ETE) é uma opção diagnóstica. O manejo inclui fluidos intravenosos e anti-hipertensivos como medida temporária, manejo cirúrgico definitivo e, em alguns casos, manejo expectante ou diferido. Pacientes instáveis ou com sinais de ruptura iminente devem ser encaminhados imediatamente para cirurgia. O manejo cirúrgico precoce impactou a mortalidade. Apesar dos avanços nas técnicas cirúrgicas, a técnica cirúrgica aberta documenta maior taxa de mortalidade do que o manejo endovascular, que apresenta inúmeras vantagens por ser minimamente invasivo. Esta é uma revisão narrativa que destaca alguns aspectos-chave sobre os mecanismos de lesão, diagnóstico e manejo inicial do trauma contuso da aorta torácica. Finalmente, é proposto um algoritmo para tratar o trauma aórtico.

Changes related to muscle autophagy after exhaustive exercise and blunt trauma / Cambios relacionados con la autofagia muscular tras ejercicio exhaustivo y traumatismo contuso / Alterações relacionadas à autofagia muscular após exercício exaustivo e trauma contuso

ABSTRACT Objective: To study the temporal changes of autophagy related factors in skeletal muscle of rats after exhaustive exercise and blunt trauma. Methods: Forty-two male SD rats were divided into 7 groups with 6 rats in each group: Quiet control group (C), immediately after exhaustive exercise (E0), 24 hours after exhaustive exercise (E24), 48 hours after exhaustive exercise (E48), immediately after blunt trauma (D0), 24 hours after blunt trauma (D24), 48 hours after blunt trauma (D48). All groups of rats were killed and samped respectively at different time points specified above, and the right gastrocnemius muscle was taken, which was divided into two parts, one for mRNAs of, Lamp-2, BNIP3 and NIX by real-time fluorescent quantitative PCR, and the other for p62 protein by Western blotting. Results: (1) Compared with group C, mRNA levels of p62, Lamp-2 and NIX in group E48 were significantly increased after exhaustive exercise(P<0.05), suggesting that autophagy increased in 48h after exhaustive exercise. (2) Compared with group C, p62mRNA and Lamp-2 mRNA levels were significantly increased immediately after blunt trauma(P<0.05) and decreased significantly in 48h after blunt trauma(P<0.05), suggesting that autophagy activity was enhanced immediately after blunt trauma and decreased in 48h after injury. Conclusions: Generally, there were differences at each recovery phase between blunt trauma and exhausted exercise models, and the basal autophagy factors and mitochondrial autophagy factors were also inconsistent. Basal autophagy factors p62 and Lamp-2 increased significantly 48 hours after eccentric exhaustive exercise and immediately after blunt trauma. Mitochondrial autophagy factor BNIP3 did not increase after exhaustive exercise and blunt trauma, but NIX only increased after exhaustive exercise. Its molecular mechanism needs to be further studied. Level of Evidence III; Therapeutic Studies Investigating the Results of Treatment.

RESUMEN Objetivo: Estudiar los cambios temporales de los factores relacionados con la autofagia en el músculo esquelético de ratas tras el ejercicio exhaustivo y el traumatismo contuso. Métodos: Se dividieron 42 ratas SD macho en 7 grupos con 6 ratas en cada grupo: grupo de control silencioso (C), inmediatamente después del ejercicio exhaustivo (E0), 24 horas después del ejercicio exhaustivo (E24), 48 horas después del ejercicio exhaustivo (E48), inmediatamente después de un traumatismo contuso (D0), 24 horas después de un traumatismo contuso (D24), 48 horas después de un traumatismo contuso (D48). Todos los grupos de ratas fueron sacrificados y rotulados, respectivamente, en diferentes momentos especificados anteriormente, y se extrajo el músculo gastrocnemio derecho, dividido en dos partes, una para los ARNm Lamp-2, BNIP3 y NIX mediante PCR cuantitativa fluorescente en tiempo real, y la otra para la proteína p62 mediante Western blotting. Resultados: (1) En comparación con el grupo C, los niveles de ARNm de p62, Lamp-2 y NIX en el grupo E48 aumentaron significativamente tras el ejercicio exhaustivo (P<0,05), lo que sugiere que la autofagia aumentó en las 48 horas posteriores al ejercicio exhaustivo. (2) En comparación con el grupo C, los niveles de ARNm de p62 ARNm y Lamp-2 aumentaron significativamente inmediatamente después del traumatismo contuso (P<0,05) y disminuyeron significativamente a las 48 horas después del traumatismo contuso (P<0,05), lo que sugiere que la actividad de autofagia aumentó inmediatamente después del traumatismo contuso y disminuyó a las 48 horas después de la lesión. Conclusión: En general, hubo diferencias en cada fase de recuperación entre los modelos de traumatismo contuso y ejercicio exhaustivo, y los factores de autofagia basal y los factores de autofagia mitocondrial también fueron inconsistentes. Los factores de autofagia basal p62 y Lamp-2 aumentaron significativamente 48 horas después del ejercicio excéntrico exhaustivo e inmediatamente después del traumatismo contuso. El factor de autofagia mitocondrial BNIP3 no aumentó tras el ejercicio exhaustivo y el traumatismo contuso, pero NIX sólo aumentó tras el ejercicio exhaustivo. Su mecanismo molecular debe investigarse con más detalle. Nivel de Evidencia III; Estudios Terapéuticos que Investigan los Resultados del Tratamiento.

RESUMO Objetivo: Estudar as alterações temporais dos fatores relacionados à autofagia no músculo esquelético de ratos após exercício exaustivo e trauma contuso. Métodos: Quarenta e dois ratos machos SD foram divididos em 7 grupos com 6 ratos em cada grupo: Grupo de controle silencioso (C), imediatamente após o exercício exaustivo (E0), 24 horas após o exercício exaustivo (E24), 48 horas após o exercício exaustivo (E48), imediatamente após o trauma contuso (D0), 24 horas após o trauma contuso (D24), 48 horas após o trauma contuso (D48). Todos os grupos de ratos foram mortos e rotulados, respectivamente, em diferentes momentos especificados acima, e o músculo gastrocnêmio direito foi retirado, dividido em duas partes, uma para mRNAs de Lamp-2, BNIP3 e NIX por PCR quantitativo fluorescente em tempo real, e a outra para a proteína p62 por imunotransferência. Resultados: (1) Em comparação com o grupo C, os níveis de mRNA de p62, Lamp-2 e NIX no grupo E48 aumentaram significativamente após o exercício exaustivo (P<0,05), sugerindo que a autofagia aumentou em 48 horas após o exercício exaustivo. (2) Em comparação com o grupo C, os níveis de mRNA de p62mRNA e Lamp-2 foram significativamente aumentados imediatamente após o trauma contuso (P<0,05) e diminuíram significativamente em 48 horas após o trauma contuso (P<0,05), sugerindo que a atividade de autofagia foi aumentada imediatamente após o trauma contuso e diminuiu em 48 horas após a lesão. Conclusão: Houve, via de regra, diferenças em cada fase de recuperação entre os modelos de trauma contuso e de exercício exaustivo, sendo que os fatores de autofagia basal e os fatores de autofagia mitocondrial também foram inconsistentes. Os fatores de autofagia basal p62 e Lamp-2 aumentaram significativamente 48 horas após o exercício excêntrico exaustivo e imediatamente após o trauma contuso. O fator de autofagia mitocondrial BNIP3 não aumentou após o exercício exaustivo e o trauma contuso, mas o NIX aumentou somente após o exercício exaustivo. Seu mecanismo molecular precisa ser investigado com mais detalhes. Nível de Evidência III; Estudos Terapêuticos que Investigam os Resultados do Tratamento.

Neumatocele traumático: una presentación inusual del trauma cerrado de tórax en paciente de 21 años / Traumatic pneumatocele: an unusual presentation of blunt chest trauma in a 21-year-old patient

El neumatocele traumático, o pseudoquiste pulmonar traumático, es una complicación infrecuente del trauma cerrado de tórax, caracterizada por lesiones cavitadas únicas o múltiples de paredes fibrosas bien delimitadas, sin revestimiento epitelial. Representa un reto diagnóstico ante la prevalencia de etiologías más frecuentes de cavitación pulmonar, presentación clínica inespecífica y el carácter subreportado de la patología. Se presenta el caso de un paciente de 21 años, con cuadro clínico de fiebre y dolor torácico posterior a traumatismo contuso por accidente en motocicleta, con identificación de una lesión cavitada rodeada de vidrio esmerilado, ubicada en lóbulo superior derecho en tomografía de tórax. Se ofreció tratamiento antibiótico ante la sospecha clínica de sobreinfección. Sin embargo, se atribuyó la alteración pseudoquística pulmonar al antecedente traumático. En ocasiones las cavitaciones pulmonares postrauma no son identificadas en la atención inicial, por ende, es fundamental la evaluación clínica e imagenológica subsecuente.

Traumatic pneumatocele, or traumatic pulmonary pseudocyst, is a rare complication of blunt chest trauma, characterized by multiple or unique cavitary lesions, with well-defined fibrous walls without epithelial lining. It represents a diagnostic challenge due to the higher prevalence of other etiologies of lung cavities, nonspecific clinical features and the under-reported nature of this pathology. We present the case of a 21-year-old male with fever and chest pain after a blunt chest trauma in a motorcycle accident, with identification of a cavity in the right upper lobe, surrounded by ground glass opacities. Antibiotic therapy was administered after clinical suspicion of superinfection, however, the cavitary lesion was attributed to the trauma. Occasionally, traumatic pulmonary pseudocysts are not identified during initial assessment, therefore, clinical and imagenologic follow-up is essential.

Hernias traumáticas de la pared abdominal en pediatría: serie de tres casos / Traumatic hernias of the abdominal wall in pediatrics: Series of three cases

Introducción. Las hernias traumáticas de la pared abdominal son una entidad de muy rara ocurrencia en niños, con pocos casos descritos. Son lesiones causadas por trauma cerrado cuando las fuerzas resultantes del trauma no tienen la suficiente energía para romper la piel, pero son suficientes para producir una disrupción de las fibras musculares y la fascia. Métodos. Se presentan tres casos clínicos de niños con hernias traumáticas, el primero tipo I y los otros dos, tipo II, cuyo diagnóstico y tratamiento quirúrgico se llevaron a cabo por el servicio de cirugía pediátrica en un hospital de alto nivel de atención en Colombia. Resultados. Los tres pacientes fueron llevados a manejo quirúrgico sin prótesis, el primero por abordaje abierto y los otros dos por cirugía videoasistida, con buena evolución y sin recidivas en el seguimiento. Discusión. Las hernias traumáticas de la pared abdominal son más frecuentes en varones, como en nuestros casos, y del lado derecho. El diagnóstico de este tipo de hernias es clínico y se apoya en imágenes, teniendo en cuenta que no hay antecedente de hernia en la región afectada. El tratamiento es quirúrgico, pero es controversial el momento del mismo y el uso de materiales protésicos, puesto que existe la posibilidad de recidiva en los primeros meses en los casos de reparo primario. Conclusión. A pesar de la rareza de esta entidad, presentamos tres pacientes pediátricos a quienes se les realizó diagnóstico y manejo quirúrgico tempranos, con buena evolución y seguimiento a más de tres años.

Introduction. Traumatic hernias of the abdominal wall in children are a very rare entity, with few cases described. They are injuries caused by blunt trauma when the forces resulting from low-energy trauma to break the skin, but enough to produce a disruption of the muscle fibers and fascia. Methods. Three clinical cases of traumatic hernias in children are presented, one type I and the other two type II, whose diagnosis and surgical treatment were carried out by the pediatric surgery service in a high-level hospital in Colombia. Results. The three patients underwent surgical management without prosthesis, one by open approach and the other two by video-assisted surgery, with good evolution and no recurrence during follow-up. Discussion. Traumatic hernias of the abdominal wall are more common in male patients as in our cases, and on the right side of the abdomen. The diagnosis of this type of hernia is clinical and based on images, taking into account that there is no history of hernia in the affected region. The treatment is surgical, but its timing and the use of prosthetic materials are controversial, since there is the possibility of recurrence in the first few months in cases of primary repair. Conclusion. Despite the rarity of this entity, we present three pediatric patients who underwent early diagnosis and surgical management, with good evolution and follow-up for more than three years.

Tratamiento mininvasivo de las complicaciones del traumatismo hepático cerrado / Minimally invasive management of blunt hepatic trauma complications

RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.

ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.

Changes in ocular surface after withdrawal of anti-glaucoma medications following non-penetrating deep sclerectomy

Purpose: To analyze the ocular surface changes in eyes after the withdrawal of anti?glaucomatous drugs when non?penetrating deep sclerectomy (NPDS) is performed. Methods: Thirty?one patients (33 eyes) diagnosed with glaucoma that underwent NPDS were included in this prospective study. The control group included 33 eyes. Four variables were studied using Keratograph 5M (K5M): ocular hyperemia (OH), non?invasive tear film break?up time (NI?BUT), lower tear meniscus height (LTMH), and meibography. LTMH was also measured using the anterior segment module of a Spectralis Fourier?domain optical coherence tomography (FD?OCT) instrument. Moreover, an evaluation of corneal and conjunctival staining was performed. In the glaucoma group, five visits were carried out: pre?surgery, 1 week after surgery, and 1 month, 3 months, and 6 months after surgery. In control groups, examinations were performed in only one visit. In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ?25) before and 6 months after surgery. Results: Before NPDS, eyes showed worse objective data than healthy control subjects (P ? 0.049). In this group, a significant improvement was observed in questionnaire responses (P < 0.001), LTMH?FD?OCT (P = 0.037), LTMH?K5M (P = 0.025), K5M?OH (P = 0.003), NI?BUT (P = 0.022), and conjunctival and corneal staining (P < 0.001). No significant differences were observed between groups in FD?OCT and K5M LTMH, NI?BUT, corneal?conjunctival staining, nor in the most OH sector values at 6 months (P ? 0.62). Conclusion: A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawal of the topical anti?glaucomatous treatment had a beneficial effect on the subjects

Viscocanalostomy and combined phacoemulsification with viscocanalostomy: A five-year follow-up

Purpose: To assess the effectiveness and safety of viscocanalostomy (VC) and phaco?viscocanalostomy (PV) surgeries in eyes with a five?year follow?up. Methods: Retrospective review of patients who underwent VC and PV between January 2010 and December 2012 in the Stanley Eye Unit Abergele, UK. Patients were included for the analysis if they had a full 5?year follow?up or required redo surgery in the 5?year period. Success was defined as an intraocular pressure (IOP) of <21 mmHg. The subanalysis included IOP <16 mmHg, IOP reduction >20%, and IOP reduction >30%, the complication rate, and the drop in the use of glaucoma medications post?surgery. Results: A total of 370 eyes from 303 patients were included for the analysis. The mean preoperative IOP was 23 mmHg ± 5.3 mmHg with an average of 3.0 ± 0.1 medications. By year 5, this was reduced to 14.3 mmHg ± 6.5 mmHg with a mean of 1.0+/? 0.9 medications; 47.8% of the eyes had an IOP of <21 mmHg by year 5 without medication with a total of 92.6% of the eyes reaching this target with medication. The main complication in this group was the perforation of the Trabeculo Descemet’s Window (TDW) but this was not associated with a poorer outcome. Conclusion: This large data set of eyes undergoing VC surgery demonstrates the effectiveness and safety of this technique over 5 years

Algorithms for clinical assessment of the cervical spine in patients with severe trauma: a mixed-method analyzis / Algoritmos de avaliação clínica da coluna cervical em pacientes com traumatismo grave: uma análise mista / Algoritmos de evaluación clínica de la columna cervical en pacientes con traumatismo grave: un análisis mixto

ABSTRACT Objective: Cervical trauma is an important cause of morbidity and mortality, affecting 2% of patients admitted to emergency units. Therefore, this study aims to compare the use of two clinical cervical spine evaluation algorithms, the Canadian C-Spine Rule (CCR) and the National Emergency X-radiography Utilization Study (NEXUS). Methods: A descriptive study of the use of the two algorithms by medical residents in the initial assessment of severely traumatized patients admitted to the regional emergency unit was conducted. The evaluation of the indication for imaging tests and the positive predictive value of the algorithms were the parameters analyzed. Finally, the residents answered a questionnaire evaluating the applicability, degree of confidence and advantages of both flowcharts. Results: There was no significant difference between the number of indications for imaging or their predictive values. In the analysis of the questionnaires, the CCR proved to be more reliable and the NEXUS more applicable, and the positive and negative points of applying each of them were highlighted. Conclusion: It is concluded that the two methods are similar in detecting injuries and optimizing the use of imaging exams, being equally indicated to evaluate cervical trauma. However, the technical specifics of each must be taken into account when deciding which to use. Level of evidence IV; Descriptive Study.

RESUMO Objetivo: O trauma cervical é uma importante causa de morbidade e mortalidade, com acometimento de 2% dos pacientes admitidos nas unidades de emergência. Assim sendo, a pesquisa visa comparar a utilização de dois algoritmos clínicos de avaliação da coluna cervical: Canadian C-Spine Rule (CCR) e National Emergency X-radiography Utilization Study (NEXUS). Métodos: Foi realizado um estudo descritivo da utilização dos dois algoritmos por médicos residentes na avaliação inicial de pacientes traumatizados graves admitidos na unidade de emergência regional. A avaliação da indicação de exames de imagem e do valor preditivo positivo dos algoritmos foram os parâmetros analisados. Por fim, os residentes responderam a um questionário de avaliação da aplicabilidade, grau de confiança e vantagens de ambos os fluxogramas. Resultados: Não houve diferença significativa entre os números de indicação para imagem nem dos valores preditivos. Na análise do questionário, o CCR mostrou-se mais confiável e o NEXUS foi mais aplicável, sendo destacados os pontos positivos e negativos da aplicação de cada um deles. Conclusões: Conclui-se que houve semelhança na detecção de lesões e otimização da utilização de exames de imagem entre os dois métodos, sendo igualmente indicados para avaliação de traumatismo cervical, contudo cada um tem especificidades técnicas que devem ser levadas em conta no momento da escolha. Nível de evidência IV; Estudo descritivo.

RESUMEN Objetivo: El trauma cervical es una importante causa de morbilidad y mortalidad, con acometimiento de 2% de los pacientes admitidos en las unidades de emergencia. Siendo así, la investigación tiene como objetivo comparar el uso de dos algoritmos clínicos de evaluación de la columna cervical: Canadian C-Spine Rule (CCR) y National Emergency X-radiography Utilization Study (NEXUS). Métodos: Fue realizado un estudio descriptivo del uso de los dos algoritmos por médicos residentes en la evaluación inicial de los pacientes traumatizados graves admitidos en la unidad de emergencia regional. La evaluación de la indicación de exámenes de imagen y del valor predictivo positivo de los algoritmos fueron los parámetros analizados. Finalmente, los residentes respondieron un cuestionario de evaluación de la aplicabilidad, grado de confianza y ventajas de ambos diagramas de flujo. Resultados: No hubo diferencia significativa entre los números de indicación para imagen ni de los valores predictivos. En el análisis del cuestionario, el CCR se mostró más confiable y el NEXUS fue más aplicable, siendo destacados los puntos positivos y negativos de la aplicación de cada uno de ellos. Conclusiones: Se concluye que hubo semejanza en la detección de lesiones y optimización del uso de exámenes de imagen entre los dos métodos, siendo igualmente indicados para la evaluación de traumatismo cervical, aunque cada uno tiene especificidades técnicas que deben ser llevadas en cuenta en el momento de elegir. Nivel de evidencia IV; Estudio descriptivo.

Challenging chest drainage: a case report / Drenaje torácico desafiante: reporte de un caso

Introduction. Chest trauma is one of the most common causes of death corresponding to 20 to 25 % of cases. The majority of the patients (85%), can be managed with only a tube thoracostomy. Our objective by presenting this case report is to provide an example of how to manage a challenging chest tube thoracostomy in a patient with cardiac hernia diagnosed in the preoperative phase, based on signs of computed tomography. Case report. A 45-year-old male presented to our emergency department who fell from a light pole 7 meters high. He fell to the ground on his back. Physical examination revealed a huge subcutaneous emphysema on his entire anterior chest wall and presented no sensitivity or movements below the navel line. After the initial assessment and management care, the patient improved. As the patient stabilized we decided to go to CT. The scan revealed pericardial rupture with only the right pericardial circumference intact, the heart herniated into the left pleural space, bilateral pneumothorax, small right hemothorax and a relevant subcutaneous emphysema surrounding the chest. We decided to perform the blunt dissection technique to insert chest tubes bilaterally because of safety. After performed it the patient was transferred to cardiothoracic department. Discussion. There is a variety of techniques to perform tube thoracostomy but the blunt dissection remain the safer, especially when we are facing an anatomic distortion of the heart. Conclusion. We present a case report of a challenging thoracic drainage performed in a patient with traumatic cardiac hernia, which procedure was successful

Introducción. El traumatismo torácico es una de las causas más comunes de muerte y corresponde al 20 a 25 % de los casos. La mayoría de los pacientes (85 %) pueden tratarse solo con toracostomía. Nuestro objetivo al presentar este informe de caso es proporcionar un ejemplo de cómo manejar una toracostomía desafiante en un paciente con hernia cardíaca, diagnosticada en la fase preoperatoria, basada en signos de tomografía computarizada. Presentación del caso. Paciente masculino de 45 años que ingresa a nuestro departamento de emergencias luego de caída de 7 metros de altura (poste de luz), cayendo de espaldas al suelo. El examen físico reveló un enfisema subcutáneo importante en todo el tórax anterior y sin sensibilidad ni movimientos debajo de la línea del ombligo. Después de la evaluación y atención inicial el paciente mejoró y se decidió realizar una tomografía computarizada que reveló la rotura pericárdica, con solo la circunferencia pericárdica derecha intacta, el corazón herniado en el espacio pleural izquierdo, neumotórax bilateral, pequeño hemotórax en el lado derecho y enfisema subcutáneo rodeando completamente el tórax. Se escogió una técnica de disección roma para insertar el tubo torácico en ambos hemitórax, debido a su mayor seguridad. Posteriormente, el paciente fue trasladado al departamento de cirugía cardiotorácica. Discusión. Existe una variedad de técnicas para realizar una toracostomía con sonda, pero la disección roma sigue siendo la más segura, especialmente cuando enfrentamos una distorsión anatómica del corazón. Conclusión. Presentamos el caso de un drenaje torácico desafiante practicado a un paciente con hernia cardíaca traumática, con éxito.

Outcome evaluation of non-penetrating trabecular surgery combined with suture trabeculotomy for the treatment of primary congenital glaucoma / 中华实验眼科杂志

Objective:To investigate the efficacy and safety of non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma (PCG).Methods:An observational case series study was conducted.A total of 29 cases (50 eyes) with PCG, including 21 males (35 eyes) and 8 females (15 eyes), were enrolled in Jiangsu Province Hospital and Nanjing Children's Hospital from January to November, 2019.The age of subjects ranged from 1 month to 4 years, and the median age was 6 months.Non-penetrating trabecular surgery was first performed in order to open the Schlemm canal.The cannulation and nearly 360-degree suture trabeculotomy were then performed with the twisted 6-0 polypropylene suture.Intraocular pressure (IOP), corneal diameter, cup-to-disc ratio (c/d) and complications were recorded preoperatively and 1 week, 1 month, 3 months, 6 months, 9 months, 12 months, and 24 months postoperatively, and the proportion of sutures successfully passed through the Schlemm canal and the success rate of operation were recorded.This study followed the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (No.2019-SR-198). Written informed consent was obtained from the guardian of each subject prior to entering the study cohort.Results:Circumferential cannulation by suture was successfully performed in 90% of the subjects.The Harms trabeculotomy probe was applied in failed cases.Mean IOP was significantly lowered from preoperative (35.0±9.5) mmHg (1 mmHg=0.133 kPa) to (9.9±4.4), (10.0±4.2), (9.7±4.4), (9.0±2.9), (9.4±4.2), (9.3±3.3) and (9.5±3.8) mmHg at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=141.56, P<0.01). Mean corneal diameter was significantly reduced from preoperative (13.7±1.4) mm to (13.3±1.4), (12.9±1.4), (12.8±1.3), (12.7±1.2), (12.6±1.1), (12.6±1.1) and (12.8±0.4) mm at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=4.55, P<0.01). Mean c/d was significantly reduced from preoperative 0.81±0.15 to 0.55±0.22, 0.48±0.23, 0.45±0.22, 0.43±0.21, 0.41±0.20, 0.40±0.21 and 0.31±0.19 at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=21.07, P<0.01). Forty-two eyes (93.3%) achieved complete success and 45 eyes (100%) achieved qualified success at postoperative 12 months.No severe complications were observed during or after surgery. Conclusions:Non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy can effectively treat patients with PCG without any severe complications.

REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients / El REBOA como nuevo actor en el control de daños del paciente hemodinámicamente inestable con hemorragia no compresible del torso

Abstract Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.

Resumen La hemorragia no compresible del torso es una de las principales causas de muerte prevenibles alrededor del mundo. Una evaluación eficiente y apropiada del paciente traumatizado con hemorragia activa es la esencia para evitar el desarrollo del rombo de la muerte (hipotermia, coagulopatía, hipocalcemia y acidosis). Actualmente, las estrategias de manejo inicial incluyen hipotensión permisiva, resucitación hemostática y cirugía de control de daños. Sin embargo, los recientes avances tecnológicos han abierto las puertas a una amplia variedad de técnicas endovasculares que logran esos objetivos con una morbilidad mínima y un acceso limitado. Un ejemplo de estos avances ha sido la introducción del balón de resucitación de oclusión aortica; REBOA ( Resuscitative Endovascular Balloon Occlusion of the Aorta , por sus sigla en inglés ), el cual, ha tenido gran provecho entre los cirujanos de trauma alrededor del mundo debido a su potencial y versatilidad en áreas como trauma, ginecología y obstetricia, y gastroenterología. El objetivo de este artículo es describir la experiencia lograda en el uso del REBOA en pacientes con hemorragia no compresible del torso. Nuestros resultados muestran que el REBOA puede usarse como un nuevo actor en la resucitación de control de daños del paciente con trauma severo, para este fin, nosotros proponemos dos nuevos algoritmos para el manejo de pacientes hemodinámicamente inestables: uno para trauma cerrado y otro para trauma penetrante. Se reconoce que el REBOA tiene sus limitaciones, las cuales incluye un periodo de aprendizaje, su costo inherente y la disponibilidad. A pesar de esto, para lograr los mejores resultados con esta nueva tecnología, el REBOA debe ser usado en el momento correcto, por el cirujano correcto con el entrenamiento y el paciente correcto.

Esclerectomía profunda no penetrante en el glaucoma avanzado / Non-penetrating deep sclerectomy in advanced glaucoma

El tratamiento del glaucoma se realiza con el objetivo de disminuir los niveles de presión intraocular, único factor tratable hasta el momento, y debe ser individualizado. Se presenta un paciente masculino de 54 años de edad, de piel mestiza, intelectual, con antecedentes de aparente salud y diagnóstico de glaucoma desde hace 10 años. Se realizó trabeculectomía con antimetabolito (mitomicina C) en el ojo izquierdo en el año 2012 por daño glaucomatoso avanzado. En el año 2016 acudió a nuestra consulta y refirió mala visión y descontrol de la presión intraocular de ambos ojos. Se constataron cifras muy elevadas de presión intraocular en ambos ojos, superiores a 30 mmHg; en el ojo derecho la unidad de visión con su mejor corrección y un daño campimétrico muy avanzado limitado a una isla de visión central con caída hasta los 5° centrales, y el ojo izquierdo no alcanzaba la percepción luminosa. Después de combinar 3 líneas farmacológicas con la dosis máxima, los valores de la presión intraocular no eran protectores. Surgió la disyuntiva entre realizar una cirugía filtrante, temiendo al riesgo quirúrgico elevado y tratándose de un ojo único, o no practicar cirugía alguna y solo continuar con el tratamiento farmacológico a pesar de no conseguirse valores de presión intraocular meta. Se decidió realizar esclerectomía profunda no penetrante con antimetabolito (mitomicina C al 0,02 por ciento). No se presentaron complicaciones asociadas y se consiguió el descenso de la presión intraocular a 24 mmHg, por lo que al mes de la cirugía se realizó goniopuntura. Se obtuvo la presión intraocular objetivo, sin progresión del daño glaucomatoso y hubo conservación de la agudeza visual(AU)

Treatment for glaucoma is aimed at reducing the levels of intraocular pressure. This is the only factor that may be treated so far, and it should be individualized. A case is presented of a male 54-year-old mulatto patient, intellectual, with a history of apparently good health who was diagnosed with glaucoma ten years ago. Trabeculectomy with antimetabolite (mitomycin C) was performed on the patient's left eye in the year 2012 due to advanced glaucomatous damage. In the year 2016 the patient attended our service and reported poor vision and uncontrolled intraocular pressure in both eyes. Very high intraocular pressure values above 30 mmHg were confirmed in both eyes. In the right eye the vision unit with its best correction, and very advanced campimetric damage limited to a central vision island with a fall to 5° central, whereas the left eye did not achieve light perception. After combining 3 drug lines at their maximum dosage, intraocular pressure values were not protective. The dilemma arose whether to perform filtration surgery, fearing the high surgical risk, being as it was a single eye, or not to perform any surgery and just go on with the drug treatment despite not having achieved target intraocular pressure values. It was decided to perform non-penetrating deep sclerectomy with antimetabolite (0.02 percent mitomycin C). No associated complications occurred and intraocular pressured fell to 24 mmHg. Therefore, goniopuncture was performed one month after surgery. The target intraocular pressure was obtained without glaucomatous damage progression and visual acuity was preserved(AU)

Disnea por rotura espontánea traqueal en ancianos / Dyspnea due to spontaneous tracheal rupture in the elderly

Tracheal rupture is an infrequent complication with high morbidity and mortality, of multifactorial etiology, being orotracheal intubation its main cause. Spontaneous tracheal rupture usually occurs after severe coughing and/or vomiting over a weakened trachea. The diagnosis is non-specific, based on highly suggestive signs and symptoms such as subcutaneous emphysema, pneumomediastinum and respiratory distress, and its confirmation requires the performance of a bronchoscopy. The location and extent of the rupture determines the clinic. This implies the importance of an early diagnosis to avoid a poor prognosis. We present the case of an elderly male patient with a spontaneous tracheal rupture without apparent cause

La rotura traqueal es una complicación infrecuente de etiología multifactorial, con una elevada morbimortalidad, la intubación orotraqueal es su principal causa. La rotura traqueal espontánea suele producirse luego de toser o presentar vómitos intensos, sobre una tráquea debilitada. El diagnóstico es inespecífico, se basa en signos y síntomas altamente sugestivos como enfisema subcutáneo, neumomediastínico y dificultad respiratoria y su confirmación exige la realización de una broncoscopia. La localización y extensión de la rotura determinan la clínica. Esto implica la importancia del diagnóstico precoz para evitar un pronóstico infausto. Se presenta el caso de un paciente varón, de edad avanzada. con una rotura espontánea traqueal sin causa aparente

CT scanning in blunt chest trauma: validation of decision instruments / Tomografia computadorizada em trauma torácico fechado: validação de instrumentos de decisão

ABSTRACT Objective: to perform an external validation of two clinical decision instruments (DIs) - Chest CT-All and Chest CT-Major - in a cohort of patients with blunt chest trauma undergoing chest CT scanning at a trauma referral center, and determine if these DIs are safe options for selective ordering of chest CT scans in patients with blunt chest trauma admitted to emergency units. Methods: cross-sectional study of patients with blunt chest trauma undergoing chest CT scanning over a period of 11 months. Chest CT reports were cross-checked with the patients' electronic medical record data. The sensitivity and specificity of both instruments were calculated. Results: the study included 764 patients. The Chest CT-All DI showed 100% sensitivity for all injuries and specificity values of 33.6% for injuries of major clinical significance and 40.4% for any lesion. The Chest CT-Major DI had sensitivity of 100% for injuries of major clinical significance, which decreased to 98.6% for any lesions, and specificity values of 37.4% for injuries of major clinical significance and 44.6% for all lesions. Conclusion: both clinical DIs validated in this study showed adequate sensitivity to detect chest injuries on CT and can be safely used to forego chest CT evaluation in patients without any of the criteria that define each DI. Had the Chest CT-All and Chest CT-Major DIs been applied in this cohort, the number of CT scans performed would have decreased by 23.1% and 24.6%, respectively, resulting in cost reduction and avoiding unnecessary radiation exposure.

RESUMO Objetivo: realizar validação externa de dois instrumentos de decisão clínica (IDCs) - TC de tórax-All e TC de tórax-Major - em uma coorte de pacientes com trauma torácico fechado submetidos a tomografia computadorizada de tórax em centro de referência para trauma, e determinar se esses IDCs são opções seguras para solicitação seletiva de tomografias computadorizadas de tórax em pacientes com trauma torácico fechado admitidos em unidades de emergência. Métodos: estudo retrospectivo transversal de pacientes com trauma torácico fechado submetidos a tomografia computadorizada de tórax, por período de 11 meses. Os laudos da TC de tórax foram cruzados com os dados do prontuário eletrônico dos pacientes. A sensibilidade e especificidade de ambos os instrumentos foram calculadas. Resultados: o estudo incluiu 764 pacientes. O IDC TC de tórax-All apresentou sensibilidade de 100% para todas as lesões e especificidades de 33,6% para lesões de maior significado clínico e 40,4% para qualquer lesão. O IDC TC de tórax Major teve sensibilidade de 100% para lesões de maior significado clínico, que diminuiu para 98,6% para quaisquer lesões, e especificidades de 37,4% para lesões de maior significado clínico e 44,6% para todas as lesões. Conclusão: ambos os instrumentos de decisão clínica validados neste estudo mostraram sensibilidade adequada para detectar lesões torácicas na TC e podem ser usados com segurança para dispensar a avaliação da TC de tórax em pacientes sem nenhum dos critérios que definem o IDC. Se os IDCs TC de tórax-All e TC de tórax Major de tórax tivessem sido aplicados nesta coorte, o número de tomografias realizadas teria diminuído em 23,1% e 24,6%, respectivamente, resultando em redução de custos e evitando exposição desnecessária à radiação.

High grade renal trauma due to blunt injury in children: do all require intervention? / Trauma renal de alto grau devido a lesão contusa em crianças: será que todas necessitam intervenção?

ABSTRACT Introduction: The aim of this study was to analyze the presentation and management of major grade renal trauma in children. Method: A retrospective study was performed including data collected from the patients who were admitted in Pediatric surgery with major grade renal injury (grade 3 and more) from January 2015 to August 2018. Demography, clinical parameters, management, duration of hospital stay and final outcome were noted. Results: Out of 13 children (9 males and 4 females), with age range 2-12 years (mean of 8 years), reported self-fall was the commonest mode of injury followed by road traffic accident. The majority (10/13, 75%) had a right renal injury. Eight children had a grade IV injury, one had a grade V injury, and four children had grade III injury. Duration of hospital stay varied from 3 to 28 (mean of 11.7) days. Three children required blood transfusion. One child required image guided aspiration twice and two required pigtail insertion for perinephric collection. All the 13 children improved without readmission or need for any other surgical intervention. Conclusion: Children with major grade renal trauma due to blunt injury can be successfully managed without surgical intervention and minimal intervention may only be needed in select situations.

RESUMO Introdução: O objetivo deste estudo foi analisar a apresentação e tratamento de grande trauma renal em crianças. Método: Foi realizado um estudo retrospectivo incluindo dados coletados dos pacientes que foram internados na cirurgia pediátrica com lesão renal de grau importante (grau 3 ou mais) de janeiro de 2015 a agosto de 2018. Coletamos dados a respeito de demografia, parâmetros clínicos, manejo, tempo de internação e resultado final. Resultados: Das 13 crianças (9 homens e 4 mulheres) com faixa etária de 2-12 anos (média de 8 anos), a queda auto-relatada foi o modo de lesão mais comum seguido de acidente de trânsito. A maioria (10/13, 75%) apresentou lesão renal direita. Oito crianças tiveram uma lesão grau IV, uma apresentou uma lesão grau V e quatro crianças apresentaram lesão grau III. A duração da internação hospitalar variou de 3 a 28 (média de 11,7) dias. Três crianças necessitaram de transfusão de sangue. Uma criança necessitou de aspiração guiada por imagem duas vezes e duas inserções de dreno pigtail exigidas para coleções perinefréticas. Todas as 13 crianças melhoraram sem re-internação ou necessidade de qualquer outra intervenção cirúrgica. Conclusão: Crianças com trauma renal de alto grau devido a lesão contusa podem ser manejadas com sucesso sem intervenção cirúrgica, e intervenção mínima pode ser necessária apenas em situações selecionadas.

Unilateral loss of thoracic motion after blunt trauma: a sign of acute Brown-Séquard syndrome

Late-onset Brown-Séquard syndrome (BSS) is a rare condition resulting from a spinal cord injury that develops weeks to years after a blunt trauma. Acute-onset BSS after a blunt injury has been rarely reported. Here, we report on a case of BSS, in a 58-year-old man, that developed immediately after a motor vehicle accident. Upon admission, loss of right thoracic motion, complete right paresis, and loss of pain and temperature sensations below the C3 level on the left side were observed. Magnetic resonance imaging showed hyperintensities within the cervical spinal cord at the C2–C3 level, confirming the diagnosis of BSS. Thoracic motion rapidly recovered, but other neurological sequelae persisted. BSS related to cervical cord injury should be suspected when patients develop hemiparesis and contralateral sensory loss immediately after a blunt trauma. Likewise, clinicians should be aware that unilateral loss of thoracic motion could be an important sign of BSS.

Study of changes in higher-order aberrations following non-penetrating deep sclerectomy surgery augmented with sub-Tenon injection of MMC in patients with open-angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the changes in higher-order aberrations following non-penetrating deep sclerectomy surgery augmented with sub-Tenon injection of mitomycin C(MMC)in patients with open angle glaucoma<p>METHODS: Twenty eyes from 20 patients were enrolled in the study. There were 10 eyes with primary open angle glaucoma(POAG)and 10 eyes with secondary open angle(SOAG; pseudoexfoliation). Patients underwent non-penetrating deep sclerectomy surgery augmented with sub-Tenon injections(0.2 mL of MMC 0.02%)before surgery. All patients were evaluated in terms of corneal total higher-order aberrations <i>via</i> i-Trace analyzer before surgery and 1mo and 3mo after surgery. The intraocular pressure(IOP), best corrected visual acuity(BCVA), and bleb morphology were evaluated at each visit. The success rate of surgery was categorized as complete, relative, or failure.<p>RESULTS: The IOP before surgery was 24.05±3.07 mmHg with a mean of 2.85±0.67 medication, which reached to 12.30±3.32 mmHg with 0.70±0.98 medication at the 3mo follow-up. The reduction in IOP was significant at all periods of the follow-up(<i>P</i><0.001). The values of total higher-order total(HOT)root mean square(RMS)and total ocular spherical-like aberrations significantly increased at 1mo follow-up after surgery and decreased over the course of 3mo. Trefoil and total ocular coma-like aberration changes were not statistically significant at all periods after surgery. The HOT RMS, coma-like and spherical-like corneal increased significantly 1mo after surgery and decreased at the 3mo follow-up. Corneal trefoil changes were not statistically significant after surgery compared to preoperative state. Patients age and IOP did not have a significant effect on changes in HOT and corneal HOT aberrations.<p>CONCLUSION: Corneal and ocular higher-order aberrations increased within 1mo after deep sclerectomy surgery and then decreased over a 3mo period, which showed no statistically significant change compared to preoperative state. The BCVA and spherical equivalent(SE)of the patients shown no statistically significant differences compared to the preoperative state at the 3mo follow-up.

"Transorbitario" foreign body after ATV accident / Corpo estranho "transorbitário" após acidente com quadriciclo

Abstract This report aims to show an unusual case of "transorbitário" wooden foreign body causing visual loss due to optic nerve damage on the side contralateral penetration of foreign matter.

Resumo O presente relato tem o objetivo de mostrar um caso incomum de corpo estranho de madeira "transorbitário" que causou perda visual por lesão do nervo óptico do lado contralateral a penetração do corpo estranho.

Trauma abdominal fechado: manejo na unidade de terapia intensiva em um hospital pediátrico terciário / Blunt abdominal trauma: management in intensive care unit in a tertiary care pediatric hospital

O artigo tem como objetivo analisar o perfil epidemiológico e o manejo de crianças vítimas de trauma abdominal fechado na Unidade de Terapia Intensiva em um hospital pediátrico terciário. Trata-se de um estudo observacional, transversal, descritivo, por meio de análise de prontuários. Foram analisados 58 prontuários. Trinta e cinco crianças (60% do total) foram do sexo masculino. A idade média foi de 8,6 anos e a mediana de 9 anos. O tipo de lesão mais comum foi a esplênica com 35% dos casos, seguida da hepática, com 26%. A associação de lesões foi encontrada em 26% dos casos, sendo que o baço foi o principal órgão acometido dentre as associações. Os acidentes com veículos automotores foram os principais mecanismos de lesão, sendo responsáveis por 57% do total. Queda foi a segunda causa de lesão, em 31% dos casos. O tempo de permanência hospitalar médio foi de 12,8 dias, enquanto que o tempo médio aproximado de permanência na unidade de terapia intensiva foi de 37 horas. Treze crianças (22% do total) chegaram hemodinamicamente instáveis ao hospital. A chance de uma criança que chegou hemodinamicamente instável ao hospital ser submetida à cirurgia foi 7 vezes maior do que uma criança que chegou estável. Oito crianças mantiveram a instabilidade hemodinâmica após a ressuscitação volêmica. A chance de um paciente que manteve instabilidade hemodinâmica ser submetido à cirurgia foi 18 vezes maior do que uma criança que se tornou estável hemodinamicamente.

The purpose of this article is to analyze the epidemiology and management of patients with blunt abdominal trauma in the intensive care unit in a tertiary care pediatric hospital. This is an observational, cross-sectional, descriptive, through analysis of medical records. Fifty-eigth records were analyzed. Thirty-five children (60% of total) were male. The mean age was 8.6 years old and the median was 9 years old. The splenic injury was the most common type of injury, with 35% of cases, followed by the liver injury, with 26%. The injury association was found in 26% of cases, and the spleen was the main organ affected among the associations. The motor vehicle accidents were the main mechanisms of injury, accounting for 57% of the total. Fall was the second cause of injury (31% of cases). The mean length of stay in the hospital was 12.8 days, while in the intensive care unit was approximately 37 hours. Thirteen children (22% of the total) came with hemodynamic instability to the hospital. The chance of a child who came with hemodynamic instability to the hospital undergoing surgery was 7 times greater than a child who came with hemodynamic stability. Eight children maintained hemodynamic instability even after resuscitation. The chance of a patient that remained hemodynamically unstable to undergo surgery was 18 times greater than of a child who became hemodynamically stable.