Penetrating Chest Trauma with Iron Rod In-situ: A Surgical Challenge

Introduction: Chest trauma both blunt and penetratingconstitutes 10-15% of all traumas and 25% of all deaths fromtraumatic injuries.Case report: We present a case of penetrating right chesttrauma following road traffic accident (RTA) with big metallicrod in-situ, entering from right axillary region and coming outfrom posterior chest wall. The force of impact was so severethat the heavy iron rod got bent upon itself making its removala surgical challenge.Conclusion: In cases of penetrating chest trauma earlyassessment, accurate diagnosis, and rapid transport with noattempt to remove the penetrating foreign body and meticulousplanning play key role in its successful management.

Clinicoepidemiological Study of Traumatic Chest Injuries in a Tertiary Care Center

Introduction: Chest trauma is one of the most serious injuries of the chest and also a common cause of significant disabilityand mortality. Chest trauma is the leading cause of death from physical trauma after head and spinal cord injury. Thoracicinjuries are primary or a contributing cause of about one-fourth of all trauma-related deaths. Traumatic chest injuries are onthe rise mainly due to increased frequency of road traffic accidents (RTAs) and rise in community disharmony. Chest injuriesare one of the common causes of major mortality and morbidity. The management of traumatic chest injuries depends on theseverity of injury, patient accessibility to nearby hospital, and availability of resources at tertiary care center.Materials and Methods: It is a prospective study of a total of 134 patients presenting to the emergency department with chest injuriesof varying severity in Sanjay Gandhi Memorial Hospital from 1 June 2018, to 31 May 2019 had been carried out. Data collectedregarding common injury modes, age and gender distribution, pre-hospitalization practices, clinical presentations, associated injuries,severity of injuries, and management options from the hospital record section and these data were analyzed with descriptive statistics.Results: Chest trauma is most common in males in their thirties with mean age of presentation 33.47 years. The most commonmode of injury was RTA 69.4%, followed by fall from height 14.9% and assault 11.1%. Pain in chest (53%) was the most commonsymptom of blunt trauma chest in the patients of our study sample followed by dyspnea (31%) and asymptomatic (9%). Clinicalsign was tenderness over chest. About 61.2% of patients found with collection in pleural cavity, in which hemothorax (23.9%)was the most common collection followed by pneumothorax (22.4%) and hemopneumothorax (15.7%).Conclusions: Chest injury is seen commonly in RTA patients. Most of the patients of chest injury had soft tissue trauma overchest in the form of abrasions and majority of these patients can be managed by symptomatic care and simple life-savingintervention, i.e. intercostal drainage. With increased RTAs, it is needed to have public awareness regarding road safetymeasures and educating them about the first aid measures for trauma patients.

Comprehensive study of penetrating chest injury in Salem District

Introduction: Penetrating chest injuries may seriously damage the lungs, heart and other thoracic structures. Blunt injuries are most commonly deceleration injuries associated with motor vehicle crashes that result in falls or blows to the chest. Aim of study: To determine the magnitude and management of patients with chest trauma in a rural setup. Materials and methods: A study of 50 cases of chest trauma admitted in, Government Mohan Kumaramangalam Medical College Hospital, from 2013-2017. The data collected included the patient’s demographic profile; mode, type and severity of chest injuries, management scheme and outcome. Results: There were 62(79.5%) males and 38 (20.5%) females, giving a male to female ratio of 3.8:1. The age ranged between 5-67 years with a mean of 32.28 years. Blunt injuries constituted the remaining 30(38.46%) and were all as a result of road traffic accidents (RTA). All patients had chest radiographs from which the commonest lesions; simple rib fractures, hemopneumothorax, hemothorax, and pneumothorax were diagnosed. There were none with major vascular or esophageal injuries. The commonest extra-thoracic associated injuries were limb fractures and abdominal injuries Conclusion: The outcome of thoracic injuries will depend upon the health care provider’s knowledge of the physics of the event and the urgency of the diagnosis, as well as the ability to assess and manage all the variables involved. The proper approach to the patient can positively influence the quality of the assessment, the level of cooperation and the long term outcome of care.

Overview of Blunt Chest Injury with Multiple Rib Fractures.

Introduction: Thoracic trauma leading to multiple fractured ribs (MFR) remains common. The significant chest pain of multiple rib fractures can be difficult to manage and can lead to decreased pulmonary function, increased hospital stay, and increased health care expenditures. Aims: To evaluate the treatment options available for pain control in blunt chest injury with multiple rib fractures. Study Design: Internet research. Methodology: Literature review on pain management of blunt chest injury associated with multiple rib fractures was done from 1970 to 2014 using manual library search, journal publications on the subject, and Medline. Results: Various modalities have been in use including systemic modalities, regional modalities, transcutaneous modalities and cutaneous modalities. Conclusion: The current research has shown differs modalities available for control of chest pain in blunt chest injury and multiple rib fractures in the ranges of systemic therapy, regional therapy and trans-cutaneous therapy. Summation of evidences favours regional therapy over others.

Evaluation of the Optimal Site and Needle Length of Needle Thoracostomy in Chest Trauma Patients

PURPOSE: Tension pneumothorax is a life threatening condition. As an emergency treatment, needle thoracostomy with 50mm angiocatheter at the second intercostal space on the mid-clavicular line (2nd ICS/MCL) is recommended in the current guidelines. However, another site has been suggested in some studies. The purpose of this study was to determine whether the current procedure should be changed, by comparing the chest wall thicknesses (CWT) at the 2(nd) ICS/MCL and the 5(th) ICS/AAL (anterior axillary line) of injured patients. METHODS: A retrospective observational study was performed in an emergency center between May 2009 and December 2011. Medical records and computed tomography (CT) images of 140 included patients were reviewed. CWT at the 2(nd) ICS/MCL was compared with the 5(th) ICS/AAL. Moreover, the relationship between BMI (body mass index) and CWT was evaluated. RESULTS: CWT of the 2(nd) ICS/MCL was 31.7±8.5 mm on the right and 31.6±8.8 mm on the left, with no differences (p=0.42). CWT of the 5(th) ICS/AAL was 28.1±8.5 mm on the right and 27.8±7.7 mm on the left, also with no differences (p=0.30). CWT of the 2(nd) ICS/MCL was thicker than that of the 5(th) ICS/AAL (p<0.001). Nevertheless, CWT of all sites were not thicker than 50 mm (p<0.001). BMI was positively correlated with CWT. CONCLUSION: There was insufficient amount of evidences shown in this study to change the current guidelines of needle thoracostomy. However, in case of obvious patients, a long needle and 5(th) ICS/AAL site should be considered for needle thoracostomy, because CWT tended to increase as BMI increased.

Effects of early invasive mechanical ventilation on anoxia and prognosis of acute respiratory distress syndrome after chest injury / 中国综合临床

Objective To explore the clinical significance of early invasive mechanical ventilation for acute respiratory distress syndrome (ARDS) caused by thoracic trauma.Methods We retrospectively analyzed the clinical data of 93 patients of invasive mechanical ventilation in those with ARDS caused by thoracic trauma,and divided them into delayed invasive mechanical ventilation group (n =45) and timely invasive ventilation group (n =48) by the time of invasive mechanical ventilation.We compared the blood gas analysis,oxygen index,heart rate,lactic acid,muscle use score of the two groups before and after invasive mechanical ventilation and the differences of mechanical ventilation time,incidence of complications,mortality and length of hospital stay between the two groups.Results Each index of the delayed invasive mechanical ventilation group and the timely invasive ventilation group was calculated:PaO2 (63.2 ± 12.3,74.2 ± 12.1)mm Hg,PaCO2 (39.4 ±8.7,38.9 +7.6) mm Hg,PaO2/FiO2 (196.2 ± 17.8,231.4 ± 18.2),respiratory rate (27.4 ±3.7,21.1 ± 3.4) beats/min,heart rate (117.2 ± 26.8,96.0 ± 25.1) beats/min,accessory muscle use score (2.69 ± 0.15,1.67 ± 0.10),lactic acid (4.23 ± 1.70,2.12 ± 0.80) mmol/L Except for PaCO2,the differences of each index were statistically significant (t values were respectively 4.346,9.420,3.949,5.436,38.809,7.736; P ＜ 0.05).The duration of mechanical ventilation treatment (10.21 ± 1.50,6.47 ± 1.20) d and the length of hospital stay (21.53 ± 1.90,16.32 ±2.10) d of the delayed group and the timely group were significantly different (t values were respectively 12.518,13.318; P ＜ 0.01).The timely group had significantly lower mortality rate (26.7％ (12/45),14.6％ (7/48)),VAP (46.7％ (21/45),22.9％(11/48)),acute gastric mucosal lesions (33.3％ (15/45),12.5％ (6/48)),MODS (40.0％ (18/45),16.7％ (8/48)) than the delayed group (x2 values were respectively 3.86,5.81,4.49,5.70; P ＜ 0.05).There is no significant difference on the incidence of pneumothorax between the two groups (11.1％ (5/45),8.3％ (4/48)).Conclusion Invasive mechanical ventilation is an effective treatment of ARDS caused by chest trauma.Early invasive mechanical ventilation can reduce the mortality rate and shorten the duration of mechanical ventilation and hospital stay of the patients with ARDS after severe thoracic trauma.

Three Cases of Traumatic Pulmonary Pseudocysts in Old Age

In old age, a traumatic pulmonary pseudocyst is an extremely rare condition that generally develops after blunt chest trauma. It is more common among pediatric and young adult patients. We report three elderly patients who presented with chest symptoms after blunt chest trauma and whose computed tomography showed post-traumatic pulmonary pseudocysts.

A Case of Traumatic Tricuspid Regurgitation Caused by Multiple Papillary Muscle Rupture

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role.

Cuerpo extraño intratorácico post traumatismo penetrante / Thoracic foreign body after penetrating chest trauma

We present the case of a 21 year old man with an intra thoracic foreign body after penetrating chest trauma. The foreign body was the blade of a knife. It was removed through the wound, without thoracotomy or video-assisted thoracic surgery (VATS) and the patient evolved without incidents. Intra-thoracic foreign bodies secondary to penetrating trauma are rare. They are usually removed through thoracotomy or VATS. Both alternatives allow adequate exploration of the intra-thoracic structures and repair injuries that are potentially lethal. In stable patients and selected cases, they can be removed without surgery (without thoracotomy or VATS); always in an operating room and under general anesthesia, in case that surgical exploration could be needed after the procedure.

Presentamos el caso de un hombre de 21 años con un cuerpo extraño intra torácico post traumatismo penetrante. El cuerpo extraño que correspondía a la hoja de un cuchillo, fue extraído a través de la misma herida traumática, sin toracotomía ni cirugía torácica video asistida (VATS). El paciente evolucionó favorablemente. Los cuerpos extraños intra torácicos secundarios a un traumatismo penetrante son infrecuentes. Se recomienda la extracción a través de toracotomía o de VATS, ambos procedimientos permiten una adecuada exploración de las estructuras intra torácicas y reparar potenciales lesiones. En pacientes estables y casos seleccionados se pueden extraer sin cirugía (sin toracotomía o VATS); siempre en pabellón quirúrgico y bajo anestesia general, teniendo todo preparado para cirugía en caso de ser necesario.

Ruptured right atrial appendage secondary to blunt chest trauma

Rupture of one or more cardiac chambers following domestic blunt chest trauma is rare. A positive outcome depends on high level of suspicion and early surgical intervention. We report here an interesting case of a ruptured right atrial appendage in a four year old boy following a blunt crushing injury to the chest and abdomen by a heavy porcelain sink which was successfully repaired. Therefore, accurate diagnosis is very important for appropriate management.

Traumatic ventricular septal defect from car bumping: A case report and review of literatures.

A 9-year-old boy developed large apical ventricular septal defect with rapid cardiopulmonary deterioration after a blunt chest injury from a car bump. The defect was successfully repaired 10 hours later. The detailed history, investigations and treatment are reported with a review of the literatures.

Clinical Investigation of Isolated Chest Injury

PURPOSE: Injuries are the third leading cause of death in Korea. Isolated chest injury is not uncommon and shows high mortality and morbidity. Several scoring systems are used for triage and stratification for trauma patients, but no standard system is accepted. We aimed to analyze the accuracy of identification of isolated chest injury by using several scoring systems. METHODS: We reviewed a total of 75 patients admitted with isolated chest injury between January 2005 and October 2005. Medical records were reviewed by using the Injury Severity Score (ISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS). The scoring systems were compared by using statistics methods. RESULTS: The overall predictive accuracy of the TRISS was 12.5%, 12.0% greater than those of the RTS and the ISS. By using the area under the receiver operating characteristic (AUROC) curve, the TRISS showed an excellent discriminative power (AUROC 0.931) compared to the ISS (AUROC 0.926) and the RTS (AUROC 0.872). CONCLUSION: Compared with the RTS and the ISS, the TRISS is an easily applied tool with excellent prognostic abilities for isolated chest trauma patients. However, the TRISS, the ISS, and the RTS showed high specificity and low sensitivity, so another scoring system is required for triage and stratification of isolated chest injury patients.

Diagnostic Value of Ultrasonography for the Assessment of Rib Fractures

PURPOSE: Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of conventional chest radiography (chest PA, rib series) in showing a rib fracture is limited, particularly in those involving the cartilage part of the rib. We investigated the possible rib fractures. We used ultrasonography (US) to investigate possible rib fractures in patients with minor blunt chest trauma who showed no evidence of a rib fracture on the conventional chest radiography. METHODS: A total of 96 patients with minor blunt chest trauma and showing no evidence of a rib fracture on the conventional chest radiography were examined with US performed with a 7.5-MHz linear transducer. RESULTS: A total of 44(45.8%) patients showed a rib fracture whereas 52(54.2%) patients had no evidence of a rib fracture. Fracture of the rib with displacement 24 patients was the most common finding. CONCLUSIONS: Rib US is a useful imaging method in showing rib fractures overlooked on chest X-rays in cases of minor blunt chest trauma. Compared with conventional chest radiography, rib US takes a shorter time and is not difficult. Additionally, lesions combined with rib fractures and costal cartilage fractures are diagnosed more easily when using rib US.

Traumatic Aortic Regurgitation Caused by Blunt Chest Injury / 대한마취과학회지

Blunt chest trauma can result in significant cardiothoracic injury, which can include a cardiac contusion, aortic injury, and myocardial valvular injury. Traumatic aortic regurgitation is an uncommon consequence of closed chest injury. Isolated aortic valvular injury following blunt chest trauma is difficult to diagnose in a patient with multiple injuries. We report a case of traumatic aortic regurgitation which was detected just before anesthesia induction in the operating room. This report is presented to emphasize the possibility of aortic regurgitation and the need for careful evaluation of the cardiac status in patients with blunt chest trauma.

The treatment on severe craniocerebral traffic accident trauma with chest injuries / 重庆医科大学学报

Objective:To summarize the clinical features,diagnosis and treatment on patients with severe craniocerebral traffic accident trauma combined with chest injuries.Methods:The data of 53 patients with severe craniocerebral traffic accident trauma combined with chest injuries in the department where the authers worked were studied retrospectively.Results:27 patients were cured,16 patients survived with disabilities.1 patient survived in vegetative state,9 patients died.Conclusion:The traumatic condition of the patients with severe craniocerebral traffic accident trauma with chest injuries is always complicated and serious,and the mortality rate of these patients is high.Early diagnosis and prompt treatment,avoiding missed diagnosis and misdiagnosis were crucial for these patients.Keeping respiratory tract unobstructed,treating shock,cooperation among relevant departments are important to rescue the patients.