DOCSLIB.ORG

Association of Mechanism of Injury with Risk for Venous Thromboembolism After Trauma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Association of Mechanism of Injury with Risk for Venous Thromboembolism After Trauma Research JAMA Surgery | Original Investigation | ASSOCIATION OF VA SURGEONS Association of Mechanism of Injury With Risk for Venous Thromboembolism After Trauma Charles A. Karcutskie, MD, MA; Jonathan P. Meizoso, MD; Juliet J. Ray, MD; Davis Horkan, MD; Xiomara D. Ruiz, MD; Carl I. Schulman, MD, PhD, MSPH; Nicholas Namias, MD, MBA; Kenneth G. Proctor, PhD Invited Commentary page 41 IMPORTANCE To date, no study has assessed whether the risk of venous thromboembolism CME Quiz at (VTE) varies with blunt or penetrating trauma. jamanetworkcme.com OBJECTIVE To test whether the mechanism of injury alters risk of VTE after trauma. DESIGN, SETTING, AND PARTICIPANTS A retrospective database review was conducted of adults admitted to the intensive care unit of an American College of Surgeons–verified level I trauma center between August 1, 2011, and January 1, 2015, with blunt or penetrating injuries. Univariate and multivariable analyses identified independent predictors of VTE. MAIN OUTCOMES AND MEASURES Differences in risk factors for VTE with blunt vs penetrating trauma. RESULTS In 813 patients with blunt trauma (mean [SD] age, 47 [19] years) and 324 patients with penetrating trauma (mean [SD] age, 35 [15] years), the rate of VTE was 9.1% overall (104 of 1137) and similar between groups (blunt trauma, 9% [n = 73] vs penetrating trauma, 9.6% [n = 31]; P = .76). In the blunt trauma group, more patients with VTE than without VTE had abnormal coagulation results (49.3% vs 35.7%; P = .02), femoral catheters (9.6% vs 3.9%; P = .03), repair and/or ligation of vascular injury (15.1% vs 5.4%; P = .001), complex leg fractures (34.2% vs 18.5%; P = .001), Glasgow Coma Scale score less than 8 (31.5% vs 10.7%; P < .001), 4 or more transfusions (51.4% vs 17.6%; P < .001), operation time longer than 2 hours (35.6% vs 16.4%; P < .001), and pelvic fractures (43.8% vs 21.4%; P < .001); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Profile scores (13 [6] vs 8 [4]; P Յ .001). However, with multivariable analysis, only receiving 4 or more transfusions (odds ratio [OR], 3.47; 95% CI, 2.04-5.91), Glasgow Coma Scale score less than 8 (OR, 2.75; 95% CI, 1.53-4.94), and pelvic fracture (OR, 2.09; 95% CI, 1.23-3.55) predicted VTE, with an area under the receiver operator curve of 0.730. In the penetrating trauma group, more patients with VTE than without VTE had abnormal coagulation results (64.5% vs 44.4%; P = .03), femoral catheters (16.1% vs 5.5%; P = .02), repair and/or ligation of vascular injury (54.8% vs 25.3%; P < .001), 4 or more transfusions (74.2% vs 39.6%; P < .001), operation Author Affiliations: Ryder Trauma time longer than 2 hours (74.2% vs 50.5%; P = .01), Abbreviated Injury Score for the Center, Division of Trauma and Surgical Critical Care Services, DeWitt abdomen greater than 2 (64.5% vs 42.3%; P = .02), and were aged 40 to 59 years (41.9% Daughtry Family Department of vs 23.2%; P = .02); patients with VTE also had higher mean (SD) Greenfield Risk Assessment Surgery, University of Miami Leonard Profile scores (12 [4] vs 7 [4]; P < .001). However, with multivariable analysis, only repair M. Miller School of Medicine, Miami, and/or ligation of vascular injury (OR, 3.32; 95% CI, 1.37-8.03), Abbreviated Injury Score for Florida (Karcutskie, Meizoso, Ray, Horkan, Ruiz, Schulman, Namias, the abdomen greater than 2 (OR, 2.77; 95% CI, 1.19-6.45), and age 40 to 59 years (OR, 2.69; Proctor); Ryder Trauma Center, 95% CI, 1.19-6.08) predicted VTE, with an area under the receiver operator curve of 0.760. Division of Burns, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller CONCLUSIONS AND RELEVANCE Although rates of VTE are the same in patients who School of Medicine, Miami, Florida experienced blunt and penetrating trauma, the independent risk factors for VTE are different (Karcutskie, Meizoso, Ray, Horkan, based on mechanism of injury. This finding should be a consideration when contemplating Ruiz, Schulman, Namias, Proctor). prophylactic treatment protocols. Corresponding Author: Kenneth G. Proctor, PhD, Ryder Trauma Center, Divisions of Trauma, Surgical Critical Care, and Burns, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, 1800 NW 10th JAMA Surg. 2017;152(1):35-40. doi:10.1001/jamasurg.2016.3116 Ave, Ste T-215 (Box D40), Miami, FL Published online September 28, 2016. 33136 ([email protected]). (Reprinted) 35 Copyright 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 Research Original Investigation Mechanism of Injury and Risk for Venous Thromboembolism After Trauma rauma patients are typically classified according to the mechanism of injury—blunt or penetrating. However, Key Points advanced trauma life support guidelines do not distin- T Question Does mechanism of injury influence the independent 1 guish management based on the mechanism of injury. Sev- risk factors for venous thromboembolism after trauma? eral studies have found significantly different outcomes be- Finding This cohort study finds that, although the Greenfield Risk tween patients who experienced blunt and penetrating trauma Assessment Profile accurately predicts venous thromboembolism who were resuscitated to similar end points,2-5 even when se- after blunt and penetrating trauma, independent risk factors are 6-12 verity of the injuries are closely matched. different based on the mechanism of injury. Venous thromboembolism (VTE) is a significant cause Meaning Risk assessment and prophylactic strategies for venous of late morbidity and mortality after trauma13 despite thromboembolism may improve if mechanism of injury is thromboprophylaxis.14-27 At least 2 models stratify risk of VTE considered. specifically in trauma patients to guide surveillance and pro- phylaxis: the Trauma Embolic Scoring System28 and the Green- field Risk Assessment Profile (RAP).18 To our knowledge, no groups using χ2 or Fisher exact test, as appropriate. Paramet- study has assessed the differences in risk of VTE from the in- ric data are expressed as mean (SD) and compared using t tests dependent risk factors of blunt and penetrating trauma. for 2 independent samples. Nonparametric data are ex- We stratified patients in the intensive care unit by either pressed as median (interquartile range) and compared using blunt or penetrating trauma mechanism, and then deter- the Mann-Whitney test. Variables demonstrating statistical sig- mined which RAP risk factors are associated with VTE. We hy- nificance on univariate analyses were entered into a multi- pothesized that the mechanism of injury alters the indepen- variable logistic regression model. Odds ratios (ORs) and dent VTE risk factors. 95% CIs are reported. Area under the receiver operator curve (AUROC) was used to assess predictive values of models. P ≤.05 was considered statistically significant for all results. Methods This was a retrospective cohort study conducted at the Ryder Results Trauma Center in the University of Miami and Jackson Memo- rial Medical Center and was approved by the University of Mi- The study population comprised 1137 patients: 813 with blunt ami Institutional Review Board with a waiver of informed con- trauma and 324 with penetrating trauma. Patient demograph- sent. Adult patients sustaining blunt or penetrating trauma and ics and injury characteristics are shown in Table 2. admitted to the Ryder Trauma Center intensive care unit from There was no difference in rates of VTE, deep vein throm- August 1, 2011, to January 1, 2015, were included. Patients who bosis, or pulmonary embolism based on mechanism of in- were younger than 18 years, incarcerated, pregnant, or died less jury. In patients with blunt trauma, the overall VTE rate was than 72 hours after admission were excluded. 9% (n = 73), with a deep vein thrombosis rate of 6.6% (n = 54) Thirty percent of the population was concurrently en- and a pulmonary embolism rate of 2.7% (n = 22). In patients rolled in a prospective observational trial evaluating hyperco- with penetrating trauma, the overall VTE rate was 9.6% (n = 31), agulability and VTE in patients who have undergone trau- with a deep vein thrombosis rate of 7.7% (n = 25) and a pul- matic injury. This group was deemed to be at high risk for VTE, monary embolism rate of 2.5% (n = 8). using a RAP score of 10 or more, based on previous work.25,29 In patients with blunt trauma, those with VTE had a worse All high-risk patients enrolled in this concurrent study re- mean (SD) Injury Severity Score (29 [14] vs 21 [11]; P ≤ .001), ceived weekly surveillance venous duplex ultrasonography admission heart rate (102 [26] vs 95 [23] beats/min; P = .03), (VDU) of the lower extremities, in addition to chemical and me- admission systolic blood pressure (122 [30] vs 135 [32]; P = .01), chanical prophylaxis. Deep vein thrombosis was diagnosed admission Glasgow Coma Scale score (11 [5] vs 13 [4]; P ≤ .001), with VDU. Pulmonary embolism was identified by computed and base deficit (–4 [5] vs –2 [5]; P = .007). As expected, mean tomography with angiography of the chest. The VDU proto- (SD) RAP score (13 [6] vs 8 [4]; P ≤ .001) and median (inter- cols at our institution have been previously reported.30 quartile range) hospital length of stay (40 [22-78] vs 12 [7-26] Briefly, all VDUs were performed by certified ultrasonog- days; P ≤ .001) were also higher in patients with VTE. There raphy technologists and interpreted by an attending radiolo- was no difference in time to first prophylaxis between pa- gist. The deep venous systems of both lower extremities are tients with VTE and those without VTE.
Load more

Recommended publications
  • A Rare Case of Penetrating Trauma of Frontal Sinus with Anterior Table Fracture Himanshu Raval1*, Mona Bhatt2 and Nihar Gaur3
    ISSN: 2643-4474 Raval et al. Neurosurg Cases Rev 2020, 3:046 DOI: 10.23937/2643-4474/1710046 Volume 3 | Issue 2 Neurosurgery - Cases and Reviews Open Access CASE REPORT Case Report: A Rare Case of Penetrating Trauma of Frontal Sinus with Anterior Table Fracture Himanshu Raval1*, Mona Bhatt2 and Nihar Gaur3 1 Department of Neurosurgery, NHL Municipal Medical College, SVP Hospital Campus, Gujarat, India Check for updates 2Medical Officer, CHC Dolasa, Gujarat, India 3GAIMS-GK General Hospital, Gujarat, India *Corresponding author: Dr. Himanshu Raval, Resident, Department of Neurosurgery, NHL Municipal Medical College, SVP Hospital Campus, Elisbridge, Ahmedabad, Gujarat, 380006, India, Tel: 942-955-3329 Abstract Introduction Background: Head injury is common component of any Road traffic accident (RTA) is the most common road traffic accident injury. Injury involving only frontal sinus cause of cranio-facial injury and involvement of frontal is uncommon and unique as its management algorithm is bone fractures are rare and constitute 5-9% of only fa- changing over time with development of radiological modal- ities as well as endoscopic intervention. Frontal sinus inju- cial trauma. The degree of association has been report- ries may range from isolated anterior table fractures causing ed to be 95% with fractures of the anterior table or wall a simple aesthetic deformity to complex fractures involving of the frontal sinuses, 60% with the orbital rims, and the frontal recess, orbits, skull base, and intracranial con- 60% with complex injuries of the naso-orbital-ethmoid tents. Only anterior table injury of frontal sinus is rare in pen- region, 33% with other orbital wall fractures and 27% etrating head injury without underlying brain injury with his- tory of unconsciousness and questionable convulsion which with Le Fort level fractures.
    [Show full text]
  • Traumatic Intracranial Aneurysms Due to Penetrating Brain Injury. a Case Report and Suggested Management Guidelines Breck Aaron Jones MD; Alex Patrick Michael MD
    Traumatic Intracranial Aneurysms Due to Penetrating Brain Injury. A Case Report and Suggested Management Guidelines Breck Aaron Jones MD; Alex Patrick Michael MD Southern Illinois University School of Medicine Methods Learning Objectives Introduction Angiogram Traumatic intracranial aneurysms A Pubmed search of the literature Identification of traumatic intracranial pertaining to traumatic aneurysms. (TICA) are rare in occurrence and pseudoaneurysms and penetrating Classification of traumatic intracranial equally rare in the literature. Less brain trauma. The literature was aneurysms. than 1% of intracranial aneurysms reviewed for case reports and Treatment and management of are caused by blunt trauma, while management recommendations. traumatic intracranial aneurysms. even fewer are caused by penetrating trauma. Penetrating Results References Traumatic intracranial aneurysm 1.Aarabi B. Management of traumatic aneurysms caused by trauma creates a unique type of high-velocity missile head wounds. Neurosurg Clin N Am. formation is the most commonly aneurysm that does not incorporate Oct 1995;6(4):775-797. described vascular injury after 2.Rao GP, Rao NS, Reddy PK. Technique of removal of an all three vessel wall layers. Because penetrating brain injury. impacted sharp object in a penetrating head injury using the of their rarity, the natural history and Histologically, traumatic aneurysms lever principle. Br J Neurosurg. Dec 1998;12(6):569-571. 3.Vascular complications of penetrating brain injury. J can be described as true management of TICAs are not well Trauma. Aug 2001;51(2 Suppl):S26-28. Angiogram showing traumatic intracranial (incorporating intima, media, defined in the literature. Here we 4.Crompton MR. The pathogenesis of cerebral aneurysms. aneurysm following a gunshot wound to adventitia), false (incorporating one or Brain.
    [Show full text]
  • Prehospital Spine Immobilization for Penetrating Trauma—Review and Recommendations from the Prehospital Trauma Life Support Executive Committee
    REVIEW ARTICLE Prehospital Spine Immobilization for Penetrating Trauma—Review and Recommendations From the Prehospital Trauma Life Support Executive Committee Lance E. Stuke, MD, MPH, Peter T. Pons, MD, Jeffrey S. Guy, MD, MSc, MMHC, Will P. Chapleau, RN, EMT-P, Frank K. Butler, MD, Capt MC USN (Ret), and Norman E. McSwain, MD pine immobilization in trauma patients suspected of hav- In the case of penetrating injuries, delays in transport Sing a spinal injury has been a cornerstone of prehospital prolong the time before patients receive the prompt surgical treatment for decades. Current practices are based on the care needed to arrest hemorrhage. Even with experienced belief that a patient with an injured spinal column can prehospital providers, spine immobilization is time consum- deteriorate neurologically without immobilization. Most ing. The time required for experienced emergency medical treatment protocols do not differentiate between blunt and technicians to properly immobilize a cervical spine has been penetrating mechanisms of injury. Current Emergency Med- reported to be 5.64 minutes (Ϯ1.49 minutes).6 This scene ical Service (EMS) protocols for spinal immobilization of delay can be catastrophic for a patient with penetrating penetrating trauma are based on historic practices rather than trauma requiring urgent surgical intervention for airway com- scientific merits. Although blunt spinal column injuries will promise or hemorrhage. Studies have demonstrated that cervical collars increase occasionally produce unstable vertebral
    [Show full text]
  • Deaths from Abdominal Trauma: Analysis of 1888 Forensic Autopsies
    DOI: 10.1590/0100-69912017006006 Original Article Deaths from abdominal trauma: analysis of 1888 forensic autopsies Óbitos por trauma abdominal: análise de 1888 autopsias médico-legais POLYANNA HELENA COELHO BORDONI1; DANIELA MAGALHÃES MOREIRA DOS SANTOS2; JAÍSA SANTANA TEIXEIRA2; LEONARDO SANTOS BORDONI2-4. ABSTRACT Objective: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. Methods: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. Results: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gun- shot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. Conclusion: in this sam- ple. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ. Keywords: Autopsy. Forensic Medicine. Homicide. Abdominal Injuries. INTRODUCTION In addition, the accuracy of abdominal phy- sical examination is low and the level of consciousness eaths from external causes represent the second produced by hemorrhages or by the association of ab- Dleading cause of mortality in Brazil and the main dominal trauma (AT) with traumatic brain injury and/or cause when considering individuals under the age of effects of central nervous system of previously consu- 351.
    [Show full text]
  • Updated Mild Traumatic Brain Injury Guideline for Adults
    Heads Up to Clinicians: Updated Mild Traumatic Brain Injury Guideline for Adults This Guideline is based on the 2008 Mild TBI Clinical Policy for adults, which revises the previous 2002 Clinical Policy. To help improve diagnosis, treatment, and outcomes for patients with mild TBI, it is critical that you become familiar with this guideline. The guideline is especially important for clinicians working in hospital-based emergency care. Inclusion Criteria: This guideline is intended for patients with non-penetrating trauma to the head who present to the ED within 24 hours of injury, who have a Glascow Coma Scale (GCS) score of 14 or 15 on initial evaluation in the ED, and are ≥ 16 years old. Exclusion Criteria: This guideline is not intended for patients with penetrating trauma or multisystem trauma who have a GCS score of < 14 on initial evaluation in the ED and are < 16 years old. Please turn over. What You Need to Know: This guideline provides recommendations for determining which patients with a known or suspected mild TBI require a head CT and which may be safely discharged. Here are a few important points to note: There is no evidence to recommend the use of a head Discuss discharge instructions with patients and give MRI over a CT in acute evaluation. them a discharge instruction sheet to take home and share with their family and/or caregiver. Be sure to: A noncontrast head CT is indicated in head trauma patients with loss of consciousness or posttraumatic • Alert patients to look for postconcussive symptoms amnesia in presence of specific symptoms.
    [Show full text]
  • Western Trauma Association Critical Decisions in Trauma: Penetrating Chest Trauma
    WTA 2014 ALGORITHM Western Trauma Association Critical Decisions in Trauma: Penetrating chest trauma Riyad Karmy-Jones, MD, Nicholas Namias, MD, Raul Coimbra, MD, Ernest E. Moore, MD, 09/30/2020 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3Ypodx1mzGi19a2VIGqBjfv9YfiJtaGCC1/kUAcqLCxGtGta0WPrKjA== by http://journals.lww.com/jtrauma from Downloaded Martin Schreiber, MD, Robert McIntyre, Jr., MD, Martin Croce, MD, David H. Livingston, MD, Jason L. Sperry, MD, Ajai K. Malhotra, MD, and Walter L. Biffl, MD, Portland, Oregon Downloaded from http://journals.lww.com/jtrauma his is a recommended algorithm of the Western Trauma Historical Perspective TAssociation for the acute management of penetrating chest The precise incidence of penetrating chest injury, varies injury. Because of the paucity of recent prospective randomized depending on the urban environment and the nature of the trials on the evaluation and management of penetrating chest review. Overall, penetrating chest injuries account for 1% to injury, the current algorithms and recommendations are based 13% of trauma admissions, and acute exploration is required in by on available published cohort, observational and retrospective BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3Ypodx1mzGi19a2VIGqBjfv9YfiJtaGCC1/kUAcqLCxGtGta0WPrKjA== 5% to 15% of cases; exploration is required in 15% to 30% of studies, and the expert opinion of the Western Trauma Asso- patients who are unstable or in whom active hemorrhage is ciation members. The two algorithms should be reviewed in the suspected. Among patients managed by tube thoracostomy following sequence: Figure 1 for the management and damage- alone, complications including retained hemothorax, empy- control strategies in the unstable patient and Figure 2 for the ema, persistent air leak, and/or occult diaphragmatic injuries management and definitive repair strategies in the stable patient.
    [Show full text]
  • ABC Ofmajor' Trauma ABDOMINAL TRAUMA BMJ: First Published As 10.1136/Bmj.301.6744.172 on 21 July 1990
    ABC ofMajor' Trauma ABDOMINAL TRAUMA BMJ: first published as 10.1136/bmj.301.6744.172 on 21 July 1990. Downloaded from Andrew Cope, William Stebbings The aim ofthis article is to enable all those concerned with the management of patients with abdominal trauma to perform a thorough examination and assessment with the help of diagnostic tests and to institute safe and correct treatment. Intra-abdominal injuries carry a high morbidity and mortality because they are often not detected or their severity is underestimated. This is particularly common in cases of blunt trauma, in which there may be few or no external signs. Always have a high index ofsuspicion ofabdominal injury when the history suggests severe trauma. Traditionally, abdominal trauma is classified as either blunt or penetrating, but the initial assessment and, if required, resuscitation are essentially the same. Blunt trauma Road traffic accidents are one of the commonest causes of blunt injuries. Since wearing seat belts was made compulsory the number of fatal head injuries has declined, but a pattern of blunt abdominal trauma that is specific to seat belts has emerged. This often includes avulsion injuries of the mesentery of the small bowel. The symptoms and signs of blunt abdominal trauma can be subtle, and consequently diagnosis is difficult. A high degree of suspicion of underlying intra-abdominal injury must be adopted when dealing with blunt trauma. Blunt abdominal trauma is -usually associated with trauma to other areas, especially the head, chest, http://www.bmj.com/ .. , :and pelvis. Penetrating trauma Penetrating wounds are either due to low velocity projectiles such as on 1 October 2021 by guest.
    [Show full text]
  • Penetrating Vascular Injuries of the Face and Neck: Clinical and Angiographic Correlation
    855 Penetrating Vascular Injuries of the Face and Neck: Clinical and Angiographic Correlation Charles M. North 1. 2 A retrospective review was made of 139 clinically stable patients who had sustained Jamshid Ahmadi penetrating trauma to the face and neck. The study was done to learn more about the Hervey D. Segall indications for angiography and the impact of angiography upon patient management. Chi-Shing Zee Some relationship between the physical examination and the angiographic findings was found. In the presence of anyone of four physical signs or symptoms (absent pulse, bruit, hematoma, or alteration of neurologic status) there was a 30% incidence of vascular injury. However, it is unlikely that a clinically significant traumatic vascular lesion will be missed if angiography is not obtained when these clinical signs and symptoms are not present. In the group of 78 patients who presented with only a wound penetrating the ' platysma and no other findings or symptoms, just two had vascular injuries on angiograms; one of these lesions was minor and the other did not affect the patient's management. There was a substantially higher rate (50%) of vascular injury in patients with trauma cephalad to the angle of the mandible compared with 11 % of patients who had neck trauma. Gunshot wounds were associated with vascular damage more frequently than were stab wounds. Angiography is often performed in penetrating trauma to the head and neck to evaluate the possibility of vascular injury and to aid in planning appropriate management [1]. Nonetheless, the role of angiography in penetrating head and neck trauma has remained controversial.
    [Show full text]
  • Modern Management of Traumatic Hemothorax
    rauma & f T T o re l a t a m n r e u n o t J Mahoozi, et al., J Trauma Treat 2016, 5:3 Journal of Trauma & Treatment DOI: 10.4172/2167-1222.1000326 ISSN: 2167-1222 Review Article Open Access Modern Management of Traumatic Hemothorax Hamid Reza Mahoozi, Jan Volmerig and Erich Hecker* Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany *Corresponding author: Erich Hecker, Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany, Tel: 0232349892212; Fax: 0232349892229; E-mail: [email protected] Rec date: Jun 28, 2016; Acc date: Aug 17, 2016; Pub date: Aug 19, 2016 Copyright: © 2016 Mahoozi HR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Hemothorax is defined as a bleeding into pleural cavity. Hemothorax is a frequent manifestation of blunt chest trauma. Some authors suggested a hematocrit value more than 50% for differentiation of a hemothorax from a sanguineous pleural effusion. Hemothorax is also often associated with penetrating chest injury or chest wall blunt chest wall trauma with skeletal injury. Much less common, it may be related to pleural diseases, induced iatrogenic or develop spontaneously. In the vast majority of blunt and penetrating trauma cases, hemothoraces can be managed by relatively simple means in the course of care. Keywords: Traumatic hemothorax; Internal chest wall; Cardiac Hemodynamic response injury; Clinical manifestation; Blunt chest-wall injuries; Blunt As above mentioned the hemodynamic response is a multifactorial intrathoracic injuries; Penetrating thoracic trauma response and depends on severity of hemothorax according to its classification.
    [Show full text]
  • Abdominal Trauma 4/4/19, 1241 AM
    Abdominal Trauma 4/4/19, 1241 AM (/microsites/cdem) Abdominal Trauma Author: Nur-Ain Nadir. MD. Director of Medical Student Education. Core Faculty, Assistant Clinical Professor. University of Illinois College of Medicine Peoria. Editor: Nicholas E. Kman, MD FACEP Director, EM Clerkship Clinical-Associate Professor of Emergency Medicine OSU Wexner Medical Center Department of Emergency Medicine 780 Prior Hall, 376 West 10th Ave, Columbus, OH 43210 Objectives Upon completion of this module, you should be able to: https://saem.org/cdem/education/online-education/m4-curriculum/group-m4-trauma/abdominal-trama Page 1 of 9 Abdominal Trauma 4/4/19, 1241 AM 1. Diagnose, resuscitate, stabilize and manage abdominal trauma patients; 2. Identify common pathophysiologic conditions in abdominal trauma patients; 3. Describe the components of a primary survey in an abdominal trauma patient; Generate a differential diagnosis of potential traumatic injuries based on history, mechanism, and physical exam; 4. List commonly utilized imaging modalities in abdominal trauma; 5. Discuss the eventual disposition of abdominal trauma patients based on their diagnosis; 6. Appreciate the necessity for emergent surgical intervention in certain abdominal trauma conditions. Introduction Abdominal trauma is seen quite often in the Emergency Department where it can take the shape of blunt or penetrating mechanisms occasionally a combination of both. Blunt abdominal trauma (BAT) is frequently encountered in the form of motor vehicle accidents (75%), followed by falls and direct abdominal impact1. Three kinds of forces are seen with BAT: shearing forces, that occur due to rapid deceleration causing tearing at fixed points of attachments. Crushing forces, that cause intra-abdominal contents to be crushed between anterior abdominal wall and posterior ribs and vertebrae; and external compression which is the sudden and rapid rise in intra-abdominal pressure leading to rupture of viscous organs.2 Penetrating abdominal trauma (PAT) is on the rise with increasing gang violence.
    [Show full text]
  • Resuscitation and Anaesthesia for Penetrating Trauma Douglas M
    Resuscitation and anaesthesia for penetrating trauma Douglas M. Bowley, Simon J. Robertson, Kenneth D Boffard and Sats Bhagwanjee Purpose of review Introduction The worldwide burden of trauma is increasing, but is unequal In 1990, about five million people died worldwide as a between nations. Trauma targets the young and productive in result of injury [1] and it is estimated that by the year society and imposes a major burden on the health infrastructure. 2020, 8.4 million people will die every year from trauma This review provides a distillation of practice in a busy urban [2]. However, volumes and patterns of injury vary trauma centre dealing with large volumes of penetrating trauma. considerably around the world; overall homicide rates Recent findings range from 1.0 per 100 000 in established market The anaesthetist holds a pivotal role in the management of economies to 44.8 per 100 000 in sub-Saharan Africa penetrating injury; the requirements of prompt airway control, [3 .]. While the United States saw a nationwide decrease early delivery to theatre and control of a physiologically brittle in the annual non-fatal firearm-related injury rate of patient can be challenging. Recognition that attempts at 40.3% between 1993 and 1997, with a 21% decline in the definitive surgery in exsanguinating patients may do more harm annual firearm-related death rate during the same period than good has made surgery a tool of resuscitation rather than [4], South Africa is battling with what has been described an end in itself. as ‘a malignant epidemic of trauma’ [5]. Penetrating Summary trauma in South Africa in the 1980s was predominantly Depending on where they practice, clinicians are more or less from stab wounds; however, in recent years gunshot likely to encounter patients with gunshot wounds.
    [Show full text]
  • Case Report PNEUMOTHORAX and PNEUMOPERITONEUM CAUSED by PENETRATING CHEST INJURY 2 4 K.A.B.M Talful Alam1, Md
    Journal of Surgical Sciences (2018) Vol. 22(1) @ 2012 Society of Surgeons of Bangladesh JOURNAL OF SURGICAL SCIENCES Case Report PNEUMOTHORAX AND PNEUMOPERITONEUM CAUSED BY PENETRATING CHEST INJURY 2 4 K.A.B.M Talful Alam1, Md. Shah Alam Sarker , Md. Khaled Hasan3, Prawesh Maharjan Abstract Pneumothorax and pneumoperitoneum caused by penetrating chest injury are rare. Pneumo• peritoneum following trauma usually indicates the presence of a perforated intraabdominal hollow viscous. Other causes of pneumoperitoneum are through the abdominal wall, through the diaphragm, through female genital tract and through retroperitoneum. Here we report an unusual case of pneumothorax and pneumoperitoneum caused by penetrat• ing injury in the posterior aspect of chest in a young male patient of 33 years who presented to us with chest & abdominal pain & breathlessness. The diagnosis was made on clinical & radio• logical examination. Tube thoracostomy was done followed by laparotomy and repair of diaphragmatic & splenic injury. Post operative recovery was uneventful & the patient was discharged on 9th p.o.d after removal of thoracostomy tube & wound stiches. Keywords: Pneumothorax, Pneumoperitoneum, Thoracostomy,Laparotomy. Introduction of the mediastinum or change in the hemi The chest serves the important functions of respira• diaphragm. tion & of protection of the vital intrathoracic & upper Pneumoperitoneum following trauma usually abdominal organs from externally applied force and is indicates the presence of a perforated intraabdomi• composed of the rigid structure of the rib cage, nal hollow viscous and the need for laparotomy2. clavicles, sternum, scapulae & heavy overlying Other causes of pneumoperitoneum are through the musculature. Penetrating chest injuries are generally abdominal wall, through the diaphragm, through 3 less common but more deadly than blunt chest injury.
    [Show full text]