"Pop in a scope": attempt to decrease the rate of unnecessary nontherapeutic laparotomies in hemodynamically stable patients with thoracoabdominal penetrating injuries.

BACKGROUND: Management of patients with thoracoabdominal penetrating injuries is challenging. Thoracoabdominal penetrating trauma may harbor hollow viscus injuries in both thoracic and abdominal cavities and occult diaphragmatic lesions. While radiological tests show poor diagnostic performance in these situations, evaluation by laparoscopy is highly sensitive and specific. Furthermore, minimally invasive surgery may avoid unnecessary laparotomies, despite concerns regarding complication and missed injury rates. The objective of the present study is to evaluate the diagnostic and therapeutic performance of laparoscopy in stable patients with thoracoabdominal penetrating injuries. METHODS: Retrospective analysis of hemodynamically stable patients with thoracoabdominal penetrating wounds was managed by laparoscopy. We collected data regarding the profile of the patients, the presence of diaphragmatic injury, perioperative complications, and the conversion rate. Preoperative imaging tests were compared to laparoscopy in terms of diagnostic accuracy. RESULTS: Thirty-one patients were included, and 26 (84%) were victims of a stab wound. Mean age was 32 years. Ninety-three percent were male. Diaphragmatic lesions were present in 18 patients (58%), and 13 (42%) had associated injuries. There were no missed injuries and no conversions. Radiography and computerized tomography yielded an accuracy of 52% and 75%, respectively. CONCLUSION: Laparoscopy is a safe diagnostic and therapeutic procedure in stable patients with thoracoabdominal penetrating wound, with low complication rate, and may avoid unnecessary laparotomies. The poor diagnostic performance of preoperative imaging exams supports routine laparoscopic evaluation of the diaphragm to exclude injuries in these patients.

Efficacy of a Novel Surgical Manikin for Simulating Emergency Surgical Procedures.

The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among SurgeMan, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.

Lesão da artéria ilíaca interna bilateral associada com trauma pélvico, tratada por intervenção arteriografia com embolização / Bilateral internal iliac artery associated with pelvic trauma, treated with radiographic intervention and embolization

Ruptura traumática do anel pélvico resulta geralmente de impacto com grande dispêndio de energia levando à ruptura do complexo ósteo-ligamentar levando a hemorragia retroperitoneal oriunda do plexo venoso posterior da pelve e de superfícies ósseo-esponjosas,que juntamente com lesões associadas acarreta cerca de 15% a 25% de mortalidade nos pacientes com lesão do anel pélvico1. Em menos de 10% dos casos ocorre sangramento deartérias conhecidas, e em menos de 1% é relatado sangramento de vasos ilíacos ou femorais2,3,4. O objetivo do presente estudo é relatar o caso de um paciente vítima de trauma contuso comfratura pélvica e instabilidade hemodinâmica persistente após fixação pélvica externa, tendosediagnosticado por arteriografia lesão artérial ilíaca interna bilateral, e tratado por radiologia inervencionista com embolização.

Pelvic ring ruptures are a cause of great mortality and morbidity in trauma patients. The fatalities are, in general, consequence of the retroperitoneal hemorrhage and other associated damages due to the great force necessary to rip the pelvic ring. The mortality in theses cases are between 15 and 25%. The hemorrhage is usually due to the posterior pelvis venous plexus and the bony surface sponge bleedings. Less than 10% of the cases its caused by the bleeding of a known artery and in only 1%. by iliac or femoral arteries The objectives ofthis study is to report a case of a patient victim of a blunt trauma, with a complex pelvic fracture and hypotension by a bilateral iliac artery injury that was diagnosed and treated by interventionist radiology...