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Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Cardiac contusion is the most commonly missed potentially fatal thoracic injury. It occurs when there is direct compression of the heart or as a result of rapid deceleration. It is often associated with sternal fracture, and in such cases the right ventricle is more commonly damaged. The diagnosis can be established from the mechanism of injury, serial cardiac enzyme measurements, electrocardiographic changes and echocardiographic evidence of ventricular wall dysfunction and/or pericardial effusion. Cardiac enzymes will be elevated.
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Request a CXR to look for the associated complications of pneumothorax, haemothorax and a widened mediastinum, not simply to visualize the fractures. A lateral sternal X-ray is indicated for a suspected sternal fracture.
Chest injuries
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Direct blunt trauma to the heart occurs usually as a result of compression against the seatbelt (or steering wheel if unrestrained) during sudden deceleration forces. About 20% of these patients may have a dysrhythmia such as sinus tachycardia, supraventricular tachycardia, ventricular extrasystole, bundle branch block or complete heart block. It can also cause persistent shock despite fluid resuscitation as a result of decreased cardiac contractility and compliance. The diagnosis should be suspected when there are signs of a sternal fracture such as bruising and tenderness.
Assessing the analgesic efficacy of oral epigallocatechin-3-gallate on epidural catheter analgesia in patients after surgical stabilisation of multiple rib fractures: a prospective double-blind, placebo-controlled clinical trial
Published in Pharmaceutical Biology, 2020
Lihong Zhang, Weifeng Liu, Haiping You, Zhiyuan Chen, Liming Xu, Hefan He
Our standard SSRF procedure combined video-assisted thoracoscopic surgery (VATS) and open reduction internal fixation (ORIF), using a muscle-sparing approach without thoracotomy (Ali-Osman et al. 2018). Moreover, to prevent iatrogenic injury caused by drilling and/or manipulation, a safe pleural space was generated. For patients with chest tubes, VATS was performed with a 30° 5 mm thoracoscope through the wound of thoracostomy. For patients without chest tubes, a 1 cm port was created along the anterior axillary line at the fifth intercostal space. ORIF was subsequently performed with a non-precontoured universal 3.5 mm metal locking plate (Althausen et al. 2011). Following ORIF, VATS was then utilised to examine screw penetration through the parietal pleura. In the case of air leakage through lung laceration, a second VATS port was created for repair and resection using a linear cutter stapler (Chou YP et al. 2014). Direct VATS visualisation was then used to direct the placement of a chest tube. For patients with unstable sternal fracture, such as segmental fracture or distraction, ORIF of the sternal fracture was performed at the same time using a pre-contoured locking plate (Chou SS et al. 2011). After SSRF, the MRF patients were admitted into the Intensive Care Unit (ICU) with endotracheal tubes in place.
Nonpenetrating trauma resulting in hemopericardium presenting as syncope
Published in Baylor University Medical Center Proceedings, 2021
Blunt cardiac injury is the most common type of cardiac trauma resulting from motor vehicle accidents (50%), pedestrian-vehicle collisions (35%), motorcycle crash (9%), and falls (6%).1,4 Usually these injuries are associated with thoracic injuries such as rib fractures, sternal fracture, pneumothorax, hemothorax, or lung contusions, which may precipitate cardiac injury.1