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Penetrating chest trauma


Birrer, Dominique Lisa; Edu, Sorin; Nicol, Andrew; Neuhaus, Valentin (2020). Penetrating chest trauma. Journal of visualized surgery, 6(9):1-8.

Abstract

Patients with penetrating chest injuries can present from asymptomatic with just small wounds to pulseless with life-threatening injuries. Cardiac injuries with a pericardial tamponade, exsanguinating hemorrhage or thoraco-abdominal injuries are typical life-threatening conditions. Most of these patients die pre-hospital. However, some of these deaths are preventable. The goal is to reduce morbidity and mortality. The key to a successful management is an immediate standardized assessment and clear treatment algorithms. Time is of paramount essence. Chest X-ray, focused sonography, and computed tomography are standard diagnostic tools. Cardiac tamponade, large hemo-, or pneumothoraces must be ruled out. Up to 80% of all patients with penetrating chest injuries can be managed non-operative, however a tube thoracostomy (18%) or sternotomy/thoracotomy (3%) are necessary in selected cases. A stable patient with a small pneumothorax/hemothorax and no relevant additional findings can be assessed and treated non-operative. A large pneumo- or hemothorax must be drained with a chest tube. Patients with a low systolic blood pressure (<90 mmHg) despite 1 to 2 liters fluid usually need surgical evaluation and treatment. Typically, a hemodynamic unstable patient with a wound that involves the central “cardiac zone” requires a sternotomy. With wounds emerging more laterally, the trauma surgeon will perform an anterolateral thoracotomy. A patient in arrest needs to be evaluated for an emergency department thoracotomy (EDT).

Abstract

Patients with penetrating chest injuries can present from asymptomatic with just small wounds to pulseless with life-threatening injuries. Cardiac injuries with a pericardial tamponade, exsanguinating hemorrhage or thoraco-abdominal injuries are typical life-threatening conditions. Most of these patients die pre-hospital. However, some of these deaths are preventable. The goal is to reduce morbidity and mortality. The key to a successful management is an immediate standardized assessment and clear treatment algorithms. Time is of paramount essence. Chest X-ray, focused sonography, and computed tomography are standard diagnostic tools. Cardiac tamponade, large hemo-, or pneumothoraces must be ruled out. Up to 80% of all patients with penetrating chest injuries can be managed non-operative, however a tube thoracostomy (18%) or sternotomy/thoracotomy (3%) are necessary in selected cases. A stable patient with a small pneumothorax/hemothorax and no relevant additional findings can be assessed and treated non-operative. A large pneumo- or hemothorax must be drained with a chest tube. Patients with a low systolic blood pressure (<90 mmHg) despite 1 to 2 liters fluid usually need surgical evaluation and treatment. Typically, a hemodynamic unstable patient with a wound that involves the central “cardiac zone” requires a sternotomy. With wounds emerging more laterally, the trauma surgeon will perform an anterolateral thoracotomy. A patient in arrest needs to be evaluated for an emergency department thoracotomy (EDT).

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Additional indexing

Item Type:Journal Article, not_refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2020
Deposited On:09 Jan 2020 10:45
Last Modified:09 Jan 2020 10:48
Publisher:AME Publishing Company
ISSN:2221-2965
OA Status:Closed
Publisher DOI:https://doi.org/10.21037/jovs.2019.10.03

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