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Thoracic Trauma (thoracic + trauma)
Kinds of Thoracic Trauma Selected AbstractsThoracic trauma in foals: post mortem findingsEQUINE VETERINARY JOURNAL, Issue 1 2003M. A. SCHAMBOURG Summary Reasons for performing study: Thoracic trauma occurs in newborn foals and may cause associated clinical signs; this condition remains poorly documented. Objectives: The purpose of this study was to describe the pathological features of thoracic trauma in newborn foals presented for necropsy examination between 1990 and 2000. Methods: Necropsy reports of foals with thoracic trauma from 1990,2000 were reviewed. Subject details, clinical signs, thoracic and abdominal lesions were noted and analysed statistically. Results: Sixty-seven (9%) of 760 necropsied foals had thoracic trauma. In 19 foals, fractured ribs were considered to be the cause of death (Group A). The remaining foals had fractured ribs (Group B, n = 20) or rib contusions (Group C, n = 28) that were incidental findings. Ribs 3 to 8 accounted for 86% of the traumatised bones. The most common site of injury was the costochondral junction and an area immediately above it (94%). In Group A, all but 2 foals died within the first 8 days post partum. Haemothorax and subsequent pulmonary collapse was cited most commonly as the cause of death (53%). Diaphragmatic rupture and hernia (n = 2) also occurred. Conclusions: The focal site, consistent location and presence of lesions during the first week post partum, all suggest that thoracic trauma in newborn foals probably occurs during parturition. Potential relevance: The description of lesions and site of occurrence of thoracic trauma in foals will increase awareness and improve the diagnosis and treatment of this life threatening condition. [source] Myocardial perforation by a stick foreign body in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2008Augusta Pelosi DVM, DACVS Abstract Objective: To report a case of myocardial perforation by a stick foreign body in a dog. Case Summary: A 3-year-old castrated male Labrador Retriever was examined because of a puncture wound seen after an unsupervised run in the woods. The wound was suspected to penetrate into the thoracic cavity on the basis of physical exam and radiographs. Uniform ventricular premature complexes (VPCs) and junctional beats were noted on electrocardiogram (ECG). Thoracotomy was performed and a 6-cm wooden stick was seen protruding from the right ventricle through the pericardium toward the sternum. The stick was removed while purse string sutures were tied around the resultant myocardial defect. Follow-up echocardiography revealed intact intracardiac structures. VPCs were treated with lidocaine and resolved completely within 24 hours of presentation. New or Unique Information Provided: Thoracic trauma can result in myocardial injury; penetration into the myocardium represents a life-threatening situation for the emergency clinician. Cardiac injury should be included in the differential diagnoses of penetrating thoracic foreign bodies. [source] Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and resultsEQUINE VETERINARY JOURNAL, Issue 7 2004F. BELLEZZO Summary Reasons for performing study: Fractured ribs are encountered quite frequently in newborn Thoroughbred foals, often with fatal outcome. Surgical repair of fractures therefore requires consideration as a means of reducing mortality. Objectives: To evaluate the repair of rib fractures using internal fixation techniques in foals at 2 different equine hospitals following similar diagnostics and case selection. Methods: The records of 14 foals that underwent internal fixation of fracture ribs were reviewed. Subject details, clinical presentation, diagnosis, surgical technique, post operative care and complications were recorded. Follow-up information was obtained in 7 foals. Results: The fractured ribs were reduced and stabilised using reconstruction plate(s), self-tapping cortical screws and cerclage wire in 12 cases, Steinmann pins and cerclage wires in 1 case and both techniques in 1 case. Not every rib was reduced on each case. Surgical reduction was performed on an average of 2 ribs, range 1,3 ribs in each foal. At the time of writing, 4 foals had been sold, one age 2 years was in training and 2 others died from unrelated causes. Conclusions: Our data support the use of surgical stabilisation utilising reconstruction plates, self-tapping cortical screws and cerclage wire for selected cases of thoracic trauma in neonatal foals. The use of Steinmann pins may be suboptimal due to cyclic failure, implant migration and the potential for iatrogenic internal thoracic trauma. Potential relevance: Foals with existing extensive internal thoracic trauma resulting from rib fracture(s), or the potential for such trauma, previously considered to have a guarded to poor prognosis for survival, may be successfully managed with internal fixation of selected fracture sites. [source] Thoracic trauma in foals: post mortem findingsEQUINE VETERINARY JOURNAL, Issue 1 2003M. A. SCHAMBOURG Summary Reasons for performing study: Thoracic trauma occurs in newborn foals and may cause associated clinical signs; this condition remains poorly documented. Objectives: The purpose of this study was to describe the pathological features of thoracic trauma in newborn foals presented for necropsy examination between 1990 and 2000. Methods: Necropsy reports of foals with thoracic trauma from 1990,2000 were reviewed. Subject details, clinical signs, thoracic and abdominal lesions were noted and analysed statistically. Results: Sixty-seven (9%) of 760 necropsied foals had thoracic trauma. In 19 foals, fractured ribs were considered to be the cause of death (Group A). The remaining foals had fractured ribs (Group B, n = 20) or rib contusions (Group C, n = 28) that were incidental findings. Ribs 3 to 8 accounted for 86% of the traumatised bones. The most common site of injury was the costochondral junction and an area immediately above it (94%). In Group A, all but 2 foals died within the first 8 days post partum. Haemothorax and subsequent pulmonary collapse was cited most commonly as the cause of death (53%). Diaphragmatic rupture and hernia (n = 2) also occurred. Conclusions: The focal site, consistent location and presence of lesions during the first week post partum, all suggest that thoracic trauma in newborn foals probably occurs during parturition. Potential relevance: The description of lesions and site of occurrence of thoracic trauma in foals will increase awareness and improve the diagnosis and treatment of this life threatening condition. [source] Effects of Delaying Fluid Resuscitation on an Injury to the Systemic Arterial VasculatureACADEMIC EMERGENCY MEDICINE, Issue 4 2002James F. Holmes MD Abstract. Objectives: To determine the effects of delaying fluid on the rate of hemorrhage and hemodynamic parameters in an injury involving the arterial system. Methods: Twenty-one adult, anesthetized sheep underwent left anterior thoracotomy and transection of the left internal mammary artery. A chest tube was inserted into the thoracic cavity to provide a continuous measurement of blood loss. The animals were randomly assigned to one of three resuscitation protocols: 1) no fluid resuscitation (NR), 2) standard fluid resuscitation (SR) begun 15 minutes after injury, or 3) delayed fluid resuscitation (DR) begun 30 minutes after injury. All of the animals in the two resuscitation groups received 60 mL/kg of lactated Ringer's solution over 30 minutes. Blood loss and hemodynamic parameters were measured throughout the experiment. Results: Total hemorrhage volume (mean ± SD) at the end of the experiment was significantly lower (p = 0.006) in the NR group (1,499 ± 311 mL) than in the SR group (3,435 ± 721 mL) or the DR group (2,839 ± 1549 mL). Rate of hemorrhage followed changes in mean arterial pressure in all groups. Hemorrhage spontaneously ceased significantly sooner (p = 0.007) in the NR group (21 ± 14 minutes) and the DR group (20 ± 15 minutes) than in the SR group (54 ± 4 minutes). In the DR group, after initial cessation of hemorrhage, hemorrhage recurred in five of six animals (83%) with initiation of fluid resuscitation. Maximum oxygen (O2) delivery in each group after injury was as follows: 101 ± 34 mL O2/kg/min at 45 minutes in the DR group, 51 ± 20 mL O2/kg/min at 30 minutes in the SR group, and 35 ± 8 mL O2/kg/min at 60 minutes in the NR group. Conclusions: Rates of hemorrhage from an arterial injury are related to changes in mean arterial pressure. In this animal model, early aggressive fluid resuscitation in penetrating thoracic trauma exacerbates total hemorrhage volume. Despite resumption of hemorrhage from the site of injury, delaying fluid resuscitation results in the best hemodynamic parameters. [source] Application of ECMO in Multitrauma Patients With ARDS as Rescue TherapyJOURNAL OF CARDIAC SURGERY, Issue 3 2007Navid Madershahian M.D. The final rescue therapy for patients with severe hypoxia refractory to conventional therapy modalities is the extracorporeal gas exchange. Methods: We report the management of three polytraumatized patients with life-threatening injuries, severe blunt thoracic trauma, and consecutive ARDS treating by extracorporeal membrane oxygenation (ECMO). Two patients suffered a car accident with severe lung contusion and parenychmal bleeding. Bronchial rupture and mediastinal emphysema was found in one of them. Another patient developed ARDS after attempted suicide with multiple fractures together with blunt abdominal and thoracic trauma. Results: All patients were placed on ECMO and could be rapidly stabilized. They were weaned from ECMO after a mean of 114 ± 27 hours of support without complications, respectively. Mean duration of ICU stay was 37 ± 23 days. Conclusions: Quick encouragement of ECMO for the temporary management of gas exchange may increase survival rates in trauma patients with ARDS. [source] Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic traumaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2008M. ROCCO Background: Blunt thoracic trauma is a major concern in critically ill patients. Repeated lung diagnostic evaluations are needed in order to follow up the clinical situation and the results of the therapeutic strategies. The aim of this prospective clinical study was to evaluate the possible role of lung ultrasound (LU) compared with bedside radiography (CXR) and computed tomography (CT) used as the gold standard in the evaluation of trauma patients admitted to the intensive care unit with acute respiratory failure. Method: A total of 15 thoracic trauma patients were studied at intensive care unit (ICU) arrival (T1) and 48 h later (T2) with CT, CXR and LU. We evaluated the presence of pleural effusion (PE) and lung contusion (LC). For this purpose the lung parenchyma was divided into 12 regions so that we could compare 180 lung regions at T1 and T2, respectively. Results: Sensitivity of ultrasound was 0.94 for PE and 0.86 for LC while specificity 0.99 and 0.97, respectively. The likelihood ratio was 94 (,+) and 0.06 (,,) for PE and 28.6 (,+) and 0.14 (,,) for LC. Conclusions: Ultrasound provides a reliable noninvasive, bedside method for the assessment of chest trauma patients with acute respiratory failure in the ICU. [source] An unusual case of traumatic pneumatocele in a nine-year-old girl: A bronchial tear with clear bronchial lacerationPEDIATRIC PULMONOLOGY, Issue 8 2009Evelyn Van Hoorebeke MD Abstract Post-traumatic pneumatoceles (traumatic pulmonary pseudocysts) after blunt thoracic trauma are not frequently observed. It is widely accepted that pneumatoceles are caused by compression of the lung resulting in bursting parenchyma, followed by decompression of the chest with negative intrathoracic pressure. We present a case of post-traumatic pneumatocele in a nine-year-old girl who was crushed under the tailboard of a horse hamper. A multislice CT of the thorax clearly demonstrated a bronchial laceration pointing to bronchial disruption as an additional causative mechanism. Pediatr Pulmonol. 2009; 44:826,828. © 2009 Wiley-Liss, Inc. [source] BLUNT CHEST TRAUMA IN CHILDHOODANZ JOURNAL OF SURGERY, Issue 8 2007Mustafa Inan Background: Although thoracic injuries are uncommon in children, their rate of morbidity and mortality is high. The aim of this study was to evaluate the clinical features of children with blunt chest injury and to investigate the predictive accuracy of their paediatric trauma scores (PTS). Methods: Between September 1996 and September 2006, children with blunt thoracic trauma were evaluated retrospectively. Clinical features and PTS of the patients were recorded. Results: There were 27 male and 17 female patients. The mean age was 7.1 ± 3.4 years, and the mean PTS was 7.6 ± 2.4. Nineteen cases were injuries caused by motor vehicle/pedestrian accidents, 11 motor vehicle accidents, 8 falls and 6 motor vehicle/bicycle or motorbike accidents. The following were noted: 28 pulmonary contusions, 12 pneumothoraxes, 10 haemothoraxes, 9 rib fractures, 7 haemopneumothoraxes, 5 clavicle fractures and 2 flail chests, 1 diaphragmatic rupture and 1 pneumatocele case. The cut-off value of PTS to discriminate mortality was found to be ,4, at which point sensitivity was 75.0% and specificity was 92.5%. Twenty-seven patients were treated non-operatively, 17 were treated with a tube thoracostomy and two were treated with a thoracotomy. Four patients who suffered head and abdominal injuries died (9.09%). Conclusion: Thoracic injuries in children expose a high mortality rate as a consequence of head or abdominal injuries. PTS may be helpful to identify mortality in children with blunt chest trauma. Blunt thoracic injuries in children can be treated with a non-operative approach and a tube thoracostomy. [source] | ||||||||||