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Management of Ballistic Face and Neck Trauma in an Austere Setting
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
This zone contains the origin of the common carotid artery, the subclavian vessels and the vertebral artery, the brachial plexus, the trachea, the oesophagus (Figure 15.4), the apex of the lung, and the thoracic duct. Acute assessment is analogous to chest injury; a chest radiograph should be taken to exclude haemo- or pneumothorax. Stable patients with Zone 1 injuries should be first assessed by CT to guide management. Since up to one-third of patients with a clinically significant Zone 1 injury may have no symptoms at their initial presentation, many centres advocate vascular evaluation of the aortic arch and great vessels, with an oesophageal evaluation. In a haemodynamically unstable patient, particularly if polytrauma is present, clinicians should be sure that the neck is the source of instability before proceeding to surgery. In the prescribe of instability or hard signs, an incision parallel to sternocleidomastoid is generally utilised (Figure 15.5(a)) and can be extended into a midline sternotomy (Figure 15.5(b)). A surgical tracheostomy is recommended in most cases.
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Penetrating chest injury may be predicted by wounds: Medial to the nipple line anteriorly or tips of the scapulae posteriorly – high risk of heart or great vessel injury.Above the umbilicus – injury to the lungs, heart or great vessels.Below the fourth intercostal space – injury to the abdominal contents as well.
Chest injuries
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Evidence of chest injury includes wounds, bleeding, abrasions and bruising. The patient has a back and sides (including the axillae), all of which must be examined. It may be sufficient to run hands under the patient’s back to feel for wounds, but especially in penetrating trauma a more formal examination of the back is required (Figure 9.3).
Training in polytrauma management in medical curricula: A scoping review
Published in Medical Teacher, 2020
Three articles discussed the role and effectiveness of implementing TMCs at the undergraduate level. David Hill described a TMC developed to address ‘perceived deficiencies of organized trauma content in many undergraduate surgical programmes’: it aimed to provide a dedicated course on trauma care, rather than the fragmented, discipline-based teaching of trauma found in many medical curricula (Hill 1993). The model combined structured teaching in Year IV and a 15-week clinical clerkship in Year VI of the 6-year undergraduate curriculum in an Australian medical school. In Year IV students were taught basic knowledge and clinical skills; these were then expanded on in Year VI to a higher level of knowledge and clinical skills, with practice on resuscitation of simulated multi-trauma patients (Hill 1993). Classroom teaching consisted of a lecture followed by rotation, in small groups, through six stations where short tutorials were conducted by tutors (experienced trauma care clinicians). Topics covered included assessment and management of airway, chest injury and haemorrhagic shock.
Appropriate Needle Length for Emergent Pediatric Needle Thoracostomy Utilizing Computed Tomography
Published in Prehospital Emergency Care, 2019
Maria J. Mandt, Kari Hayes, Fred Severyn, Kathleen Adelgais
Tension pneumothorax is a rare traumatic event that, if left untreated, can lead to rapid cardiovascular collapse and death. While the true pediatric incidence is unknown and adult literature is scant, one study of severe chest injury in adults revealed a tension pneumothorax incidence of 5% in major trauma (1). Emergent needle thoracostomy, used to relieve a tension pneumothorax, is a basic life-saving skill taught to both prehospital and in-hospital medical providers. Current advanced trauma life support (ATLS) guidelines recommend insertion of a 2-inch (5-cm), 14-gauge needle catheter in the 5th intercostal space slightly anterior to the midaxillary line (ICS-AAL) for needle decompression in the adult population. This recent change, primarily supported by cadaveric studies reporting improved success in reaching the thoracic cavity when the 4th or 5th ICS-AAL is used, does not extend to the pediatric population due to a paucity of literature (2, 3). Recommendations for children remain broad and vague in this domain, with ATLS guidelines simply cautioning the healthcare provider to “take care” when placing a 14–18 gauge needle above the 2nd or 3rd intercostal space at the midclavicular line (ICS-MCL), as longer needles may result in further complications (3).
Fatal Wounding Pattern and Causes of Potentially Preventable Death Following the Pulse Night Club Shooting Event
Published in Prehospital Emergency Care, 2018
E. Reed Smith, Geoff Shapiro, Babak Sarani
Once again, we found that the majority of potentially survivable wounds (57%) were to the torso where efforts based solely on external control of hemorrhage would not be sufficient to achieve zero preventable deaths. Several of these fatalities were from wounds to the lungs without other major vascular injury leading to the conclusion of cardiopulmonary compromise from either open or tension pneumothorax. The primacy of chest injury in CPMS is consistent between both of our studies and is different from the injury pattern reported from military combat studies. This finding is most likely related to the lack of ballistic body armor and close range of engagement and will likely continue to be significant in future CPMS events. Management of chest injury should be a focus of training for civilian first care providers, law enforcement first responders, and fire/EMS medical responders