DOCSLIB.ORG

6-Evaluation of Chest Trauma 2019.Key

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
6-Evaluation of Chest Trauma 2019.Key Keith Boniface, MD Professor of Emergency Medicine, EVALUATION OF George Washington University, Director, Emergency Ultrasound George Washington University CHEST TRAUMA Hospital Washington, DC Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES • CARDIAC CONTUSION • OTHERS Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES • CARDIAC CONTUSION • OTHERS Aortic Imaging - TTE Parasternal long-and-short axis views: • Proximal ascending aorta • Descending thoracic aorta (cross section of the aorta) Parasternal Long Axis View Ascending aorta Descending aorta Aortic Imaging - TTE Additional segments of the ascending aorta: move transducer one or two interspace cephalad Parasternal Long Axis View: 1-2 Ribs Spaces Up Ascending Ao Aortic Imaging - TTE Suprasternal notch: aortic arch Suprasternal Notch Aortic arch Aortic Imaging - TTE • Subcostal view: distal thoracic and proximal abdominal aorta • Combining images from multiple windows allows for visualization of much of the aorta Subcostal Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES 1. CARDIAC CONTUSION 2. OTHERS Preexisting Conditions Trauma is increasingly a disease of the elderly Case 1 • 86 y.o. F seen in the ED s/p fall 5-7 stairs • Injuries: ✍ Right 8th-10th rib fracture ✍ Probably eventration of right hemidiaphragm • PMHx ✍ HTN ✍ GERD ✍ Hypercholesterolemia ✍ Alzheimer dementia Case 1 • In ED: 4 mg of morphine ➙ hypotension • Admitted to T/SICU • 1 hour after ICU admission ✍ “I’m going to die” rolled her eyes and went into PEA arrest • CPR, ACLS, TEE…. Case 1 Case 1 Case 1 Case 1 Case 1 RA AV RV Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES 1. CARDIAC CONTUSION 2. OTHERS Major Vascular Injury • Aorta is the most common injury • Rupture: most patients will not reach hospital • Dissection • Pulmonary artery • Inferior and superior vena cava Aortic Rupture • Leads to death in 75-90% of cases at the time of injury • Rapid chest deceleration/compression induces torsion and shearing forces that results in transverse laceration and rupture of the aorta • Most commonly – in isthmus (inherently vulnerable) ✍ Occurs usually just distal to the origin of the left subclavian artery Aortic Rupture • Survivors have intact adventitia • Hematoma contained by parietal pleura and surrounding tissue: “false aneurysm” • Most common distal to left subclavian: 65-93% • Other sites of injury: ✍ Ascending/Arch: 7-14% ✍ Mid or distal descending: 4-12% ✍ Multiple sites: 4-13% Aortic Dissection • Life-threatening condition • An intimal tear in the aortic wall ➙ passage of blood into a “false” channel between the intima and media • This false channel may be localized or may propagate downstream • Complications: ✍ Expansion with compression of the true aortic lumen (supplies major branch vessels) ✍ Propagation down major branch vessels ✍ Thrombosis ✍ Rupture ✍ Tamponade Role of Echo in Aortic Dissection • Detection and grading of aortic insufficiency • Detection of side branch involvement • Detection of pericardial effusion Aortic Dissection - PLA View Aortic Dissection - PLA View Flap Aortic Dissection - PSA View Dissection Aortic Dissection Suprasternal View Dissection Aortic Dissection - Descending Aorta Dissection Aortic Dissection - Subcostal Hematoma Dissection Aortic Dissection - Subcostal Dissection flap TEE in blunt aortic trauma • 209 blunt trauma patients suspected of having traumatic aortic injury ✍ 42 patients (20%) diagnosed as traumatic aortic injury ✍ Angiography ‣ Sensitivity: 83%; specificity 100% ✍ TEE ‣ Sensitivity: 98%; specificity:100% ‣ Angiography failed to diagnose most intramural hematomas or small intimal flap that TEE demonstrated Goarin, J.P., et al. Anesthesiology, 2000. 93(6) Case I • 86 y.o. F seen in the ED s/p fall 5-7 stairs • One hour after ICU admission: PEA arrest • CPR ➙ ACLS ➙ TEE: critical aortic stenosis Case I Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES 1. CARDIAC CONTUSION 2. OTHERS Tamponade • Discussed previously in the course • With blunt trauma: mostly hemoperricardium • Do not forget patients with underlying pathology (pericardial effusion) Hemopericardium Case 2: Trauma activation • EMS call: ✍ 40-ish year old man collapsed at Lincoln Memorial ✍ Hit his head on the marble steps ✍ Recent flight to DC from China ✍ Tachycardic, normal blood pressure, unresponsive ✍ 5 minute ETA • EMS call with update 3 minutes later: • BP now 86/40 • EMS arrival: • CPR initiated • Trauma steps back, ACLS, PEA, intubation, epi, IVF • ? PE vs intraabdominal bleeding Echo during pulse check Case 2: Trauma activation • Pericardial fluid collection with internal mobile echoes consistent with blood • Thoracotomy • Pericardial sac opened and 500 cc clotted blood evacuated • ROSC • To OR, found type A dissection • CT surgery called in for repair Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES • CARDIAC CONTUSION • OTHERS Cardiac Injuries • May be blunt or penetrating • Single chamber injuries – stab wound (RV) • Multiple chambers – most likely from a gunshot wounds • Echo is useful in injury localization ✍ Rarely isolated injury ✍ Valvular injuries ✍ Great vessels Blunt Cardiac Injuries • Thoracic aorta injury • Myocardial Rupture (free wall vs VSD) Genoni, et al. Heart 1997;78:316-8 Pereira, et al. J Am Soc Echocardiogram 2000;13:64-5 Pillai et al. Ann Thorax Surg 2013;96(1):297-8 • Cavo-atrial tear Gajjar AH et al. J of Surg Case Reports 2011;8(8):1-4 Barranco et al. Rom J Leg Med 2017;25:346-350 • Valvular injury Nelson, et al. J Am Soc Echocardiogram 2007;20:198.e4-e5 Pasquier et al. J Trauma 2010;68:243-246 • Coronary artery injury Meluzin, et al. J Am Soc Echocardiogram 2000;13:1043-6 Al-Aqeedi et al. Heart Views 2011;12(2):71-3 • Cardiac Contusion Shapiro et al. J of Trauma 1991;31:835-840 Clancy et al. J of Trauma 2012;73(5):S301-S306 • Dysrhythmias/Commotio Cordis Cardiac Contusion • Right ventricle • Etiology: trauma, CPR • Incidence: 30% after MVA Karalis et al. J Trauma 1994;36:53-8 • Manifestation: ✍ Hypotension, arrhythmia, ST changes —> Echo: - RV free wall hypokinesis - RWMA of free wall - Improves within 1-2 weeks Cardiac Contusion TEE: Ruptured Tricuspid Valve RV Interesting Case 42 year old male Boston Marathon runner Collapsed during the race Acute shortness Intubatedof breath in ER Froth from ET tube Hypoxia Hypoxia‣ Ruptured Papillary muscle No‣ history Severe Mitral of cardiac Regurgitation problems ‣ Required“First hospitalMitral Valve visit!!” Repair Outline 1. TTE IMAGING OF THE AORTA 2. PRE-EXISTING CONDITIONS 3. INJURY TO MAJOR VESSELS 4. TAMPONADE 5. CARDIAC INJURIES • CARDIAC CONTUSION • OTHERS.
Load more

Recommended publications
  • 1 SUPPLEMENTAL MATERIAL Use of Non-Indicated Cardiac
    SUPPLEMENTAL MATERIAL Use of Non-Indicated Cardiac Testing in Low-Risk Patients: Choosing Wisely METHODS SUPPLEMENT Data Source and Study Population Using the Medicare 40% denominator file, we identified all fee-for-service Medicare beneficiaries enrolled in Medicare Parts A, B, and D (inpatient, outpatient and prescription coverage), 2006-2011, and created six annual enrollment cohorts. We excluded beneficiaries with a gap of one or more months in fee-for-service Medicare Parts A, B, or D enrollment during a calendar year. We limited our analysis to beneficiaries aged 66-80. Beneficiary characteristics, including age, sex, race/ethnicity (black, Hispanic, other), and Medicaid enrollment, were obtained from the Medicare denominator file. Residential ZIP Codes were used to assign each beneficiary to one of 306 Dartmouth Atlas of Health Care hospital referral regions (HRRs). Information on regional physician workforce in 2006 was obtained from the Dartmouth Atlas of Health Care. Defining Low- and High-Risk Cohorts To identify annual cohorts of low-risk patients, each beneficiary was annually assigned a cardiovascular disease risk status (low or high) based on records in Medicare Carrier, Outpatient, MedPAR, Hospice and Prescription Drug Event files. For each annual enrollment cohort, beneficiaries with no evidence of significant cardiovascular disease or cardiovascular disease risk were deemed low-risk and those with such conditions were deemed high-risk. Using Hierarchical Condition Category International Classification of Disease, Ninth Revision, code lists, the following diagnoses (appearing in two physician claims or one hospital claim) were considered evidence of high cardiovascular disease risk: HIV/AIDS, diabetes, drug or alcohol abuse/dependence, shock, cardiac disease (e.g.
    [Show full text]
  • A Case of Thoracic Aortic Injury Caused by Multiple Rib Fractures
    3 Case Report Page 1 of 3 A case of thoracic aortic injury caused by multiple rib fractures Weigang Zhao#, Weiwei He#, Yi Yang, Yonghong Zhao Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China #These authors contributed equally to this work. Correspondence to: Yonghong Zhao. Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishanlu Road, Shanghai 200233, China. Email: zyh5211987020@sina.com. Abstract: Thoracic aortic injury is fatal but rare in blunt chest trauma, which usually requires urgent surgical treatment. It is mostly caused by posterior rib fractures. Chest wall stabilization (CWS) has been widely performed in patients with multiple rib fractures all over the world in the past two decades with satisfactory outcomes. However, the surgical treatment of posterior rib fracture within 2–3 cm from transverse process is still a difficult problem for thoracic surgeons. Under this circumstance, rib-transverse process internal fixation method was developed and widely performed for above patients at present. In this article, we presented a case of thoracic aortic injury caused by multiple rib fractures. A 54-year-old female was admitted to our hospital with dyspnea and severe chest pain caused by a falling object. Thoracic aortic injury with multiple rib fractures were diagnosed basing on image date and emergency CWS was performed for this patient. Rib-transverse process internal fixation was not performed in this case since the patients combined with transverse process fracture. We firstly performed transverse process resection combined with CWS for this patient. The results of our study showed this method is safe and feasible for patients with multiple rib fractures combined with transverse process fracture.
    [Show full text]
  • Vertical Perspective Medical Assistance Program
    Kansas Vertical Perspective Medical Assistance Program December 2006 Provider Bulletin Number 688 General Providers Emergent and Nonemergent Diagnosis Code List Attached is a list of diagnosis codes and whether the Kansas Medical Assistance Program (KMAP) considers the code to be emergent or nonemergent. Providers are responsible for validating whether a particular diagnosis code is covered by KMAP under the beneficiary’s benefit plan and that all program requirements are met. This list does not imply or guarantee payment for listed diagnosis codes. Information about the Kansas Medical Assistance Program as well as provider manuals and other publications are on the KMAP Web site at https://www.kmap-state-ks.us. If you have any questions, please contact the KMAP Customer Service Center at 1-800-933-6593 (in-state providers) or (785) 274-5990 between 7:30 a.m. and 5:30 p.m., Monday through Friday. EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 1 of 347 Emergency Indicators as noted by KMAP: N – Never considered emergent S – Sometimes considered emergent (through supporting medical documentation) Y – Always considered emergent Diagnosis Emergency Diagnosis Code Description Code Indicator 0010 Cholera due to Vibrio Cholerae S 0011 Cholera due to Vibrio Cholerae El Tor S 0019 Unspecified Cholera S 019 Late Effects of Tuberculosis N 0020 Typhoid Fever S 0021 Paratyphoid Fever A S 0022 Paratyphoid Fever B S 0023 Paratyphoid Fever C S 024 Glanders Y 025 Melioidosis
    [Show full text]
  • Endovascular Stent in Traumatic Thoracic Aortic Dissection
    Case Report http://dx.doi.org/10.4070/kcj.2012.42.5.341 Print ISSN 1738-5520 • On-line ISSN 1738-5555 Korean Circulation Journal Endovascular Stent in Traumatic Thoracic Aortic Dissection Mi Ok Jang, MD, Ju Han Kim, MD, Sang Ki Oh, MD, Min Goo Lee, MD, Keun Ho Park, MD, Doo Sun Sim, MD, Young Joon Hong, MD, Youngkeun Ahn, MD, and Myung Ho Jeong, MD The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea Traumatic thoracic aortic injury is typically fatal. However, recent improvements in pre-hospital care and diagnostic modalities have re- sulted in an increased number of patients with traumatic aortic injury arriving alive at the hospital. Also, the morbidity and mortality as- sociated with endovascular repair are significantly lower than with conventional open surgery in traumatic thoracic aorta injury. We expe- rienced two cases of successful management of traumatic thoracic aortic dissection with endovascular stents caused by traffic accidents. (Korean Circ J 2012;42:341-344) KEY WORDS: Aorta, thoracic; Dissection; Aortography; Multidetector computed tomography. Introduction Cases Patients with blunt traumatic thoracic aorta injuries are increas- Case 1 ingly admitted to hospital due to the increasing number of traffic A 28-year-old male suffered from a traffic accident while in a car. accidents per day. Traumatic thoracic aortic injury is typically fatal. His mental status was confused but brain CT revealed non-specific The thoracic aorta wall ruptures after blunt thorax trauma and if not findings. He had no known history of hypertension, diabetes, hep- treated, has very poor outcome with an initial survival rate ranging atitis, and pulmonary tuberculosis.
    [Show full text]
  • Traumatic Diaphragmatic Hernia: 28-Years Analysis at a Brazilian University Hospital
    Traumatic diaphragmatic hernia: 28-years analysis at a Brazilian university hospital Vitor Kruger ( vitorfkruger@gmail.com ) State University of Campinas Thiago Calderan State University of Campinas Rodrigo Carvalho State University of Campinas Elcio Hirano State University of Campinas Gustavo Fraga State University of Campinas Research Article Keywords: Traumatic diaphragmatic hernia, diaphragm, hernia, diaphragmatic injury Posted Date: December 17th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-121284/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/16 Abstract Background The objective of the study is evaluate the approach to patients with acute traumatic diaphragmatic hernia at a Brazilian university hospital during a 28-year period. Traumatic diaphragmatic hernia is an uncommon injury, however its real incidence may be higher than expected. Sometimes is missed in trauma patients, and is usually associated with signicant morbidity and mortality, this analysis may improve outcomes for the trauma patient care. Methods Retrospective study of time series using and analisys database records of trauma patients at HC- Unicamp was performed to investigate the incidence, trauma mechanism, diagnosis, herniated organs, associated injuries, trauma score, morbidity, and mortality of this injury. Results Fifty-ve cases were analyzed. Blunt trauma was two-fold frequent than penetrating trauma, are associated with high grade injury and motor vehicle collision was the most common mechanism. Left side hernia was four-fold frequent than right side. Diagnose was mostly performed by chest radiography (31 cases; 56%). Associated intra-abdominal injuries were found in 37 patients (67.3%) and extra- abdominal injuries in 35 cases (63.6%).
    [Show full text]
  • Netherlands Journal of Critical Care Is Indexed In: Abstracts Dutch Annual Intensive Care Meeting 2013 Evidence
    VOLUME 16 - NO 6 - DECEMBER 2012 In this ISSUE Bi-Monthly official Journal of the Dutch Society of Intensive care (NVIC) EDITORIAL 197 Why is it so difficult to prove that rapid response systems improve patient outcome? Directions for further research FM Simmes, L Schoonhoven, J Mintjes, BG Fikkers, Netherlands Journal JG van der Hoeven REVIEW 202 of Critical Care Treatment of the delirious critically ill patient MMJ van Eijk REVIEW 208 The consequences of treatment limitations on outcome AME Spoelstra - de Man, JG van der Hoeven, LMA Heunks HOT TOPICS 223 Summary of hot topics session, European Society of Intensive Care Medicine Dr M van der Jagt CASE REPORT 208 GHB withdrawal syndrome: a possible life threatening condition L van Koppenhagen, AJ Paling CASE REPORT 211 “DRESSed” to kill: fatal case report of drug rash with eosinophilia and systemic symptoms IC Kouwenberg, R Koot, J van de Horst, HJ van Leeuwen CASE REPORT 215 Fatal Neuroleptic Malignant-like Syndrome in a Patient with Severe Parkinson’s Disease M Tolsma, AJWJ van der Lely, AL Diederik, AJ Meinders CASE REPORT 225 Coughing after drinking A.J. Kalsbeek, W. Kelder, P.C. Baas, M. Scheer CLINICAL IMAGE 218 Traumatic pneumatoceles S Houtman, R Janssen CLINICAL IMAGE 220 Pulmonary Cavities after High Energy Trauma SEM Kolderman, S Fahrentholz, JG Zijlstra Netherlands Journal of Critical Care is indexed in: AbSTRACTS DUTCH ANNUAL INTENSIVE CARE MEETING 2013 Evidence. Experience. Confi dence. bij • Invasieve candidiasis1 • Invasieve aspergillose2 • Empirische antifungale therapie3 C. albicans C. rugosaC. glabrataC. parapsilosisC. tropicalisC. kruseiC. guilliermondiiC. lipolyticaC. dubliniensisC. kefyrC. lusitaniaeA. fl avusA.
    [Show full text]
  • Investigation of the Traumatic Rupture of the Aorta (Tra) by Simulating Real-World Accidents
    INVESTIGATION OF THE TRAUMATIC RUPTURE OF THE AORTA (TRA) BY SIMULATING REAL-WORLD ACCIDENTS Chirag S. Shah, Warren N. Hardy, King H. Yang Bioengineering Center, Wayne State University, Detroit, MI, USA Chris A. Van Ee Design Research Engineering, Novi, MI, USA Richard M. Morgan and Kennerly H. Digges The George Washington University, Ashburn, VA, USA ABSTRACT Traumatic rupture of the aorta (TRA) is one of the causes of death in automotive crashes. The risk of fatality is higher if the injury is not detected and treated promptly. Numerous laboratory experiments, retrospective studies, and theories with focus on TRA have yielded limited success. Four real-world accidents with aortic injuries to the occupants were simulated using finite element (FE) methods. Two crashes were side impact, and the other two were frontal crashes. A two-phase approach was used. For Phase 1, car-to-car interaction was simulated using vehicle FE models. These simulations were validated qualitatively and quantitatively against available crash photographs and crush data. For Phase 2, interaction between the occupant and the interior of the automobile was simulated using input obtained as a result of the first phase simulation. The occupant was a mid-sized male whole-body human FE model developed at Wayne State University. For the two side impact crashes, the peri-isthmic region demonstrated the greatest maximum principal strain (MPS) and longitudinal stress (LS). For the frontal crashes, the junction of the ascending aorta and the aortic arch was the region of greatest MPS and LS. Peak MPS and peak LS averaged within the peri-isthmic region of the aorta for the second phase FE simulations ranged from 0.072 to 0.160, and 0.93 MPa to 1.58 MPa, respectively.
    [Show full text]
  • Survival After Intrapericardial IVC Rupture and Traumatic Aortic Transection
    Injury Extra 43 (2012) 134–136 Contents lists available at SciVerse ScienceDirect Injury Extra jou rnal homepage: www.elsevier.com/locate/inext Case Report Survival after intrapericardial IVC rupture and traumatic aortic transection a, b b c d a J.W. Duijff *, F. Meikle , A. El-Gamel , C. Holdaway , M. Swarbrick , G.R. Christey a Department of Trauma and General Surgery, Waikato Hospital, Hamilton, New Zealand b Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand c Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand d Department of Radiology, Waikato Hospital, Hamilton, New Zealand A R T I C L E I N F O speed. He was thrown approximately 6 m from his bike. On Article history: arrival, he had a blood pressure of 97/62 mmHg and heart rate of À1 Accepted 5 July 2012 97 min . Shortly after, his blood pressure dropped to 40/ 20 mmHg. Chest X-ray showed a large haemothorax on the right (Fig. 1) for which a chest tube was placed. This drained 1500 ml immediately but then stopped draining. He was intubated. Because of persistent haemodynamic instability the massive transfusion protocol (containing red blood cells, fresh frozen 1. Introduction plasma and platelets in a 1-1-1 ratio) was activated. He received 1 g of Tranexamic acid twice while in the ED. The FAST scan was Trauma to the great vessels in the chest is life-threatening normal and the abdomen soft and non-distended. A second chest [4,11]. These injuries are usually caused by blunt trauma with a X-ray revealed a large mediastinal haematoma as well as a large significant deceleration force [11], but can also arise from haemothorax on the left (Fig.
    [Show full text]
  • Blunt Thoracic Trauma
    CARDIOTHORACIC SURGERY II standard ATLSÔ principles, starting with control of the Airway. Blunt thoracic trauma While it is obvious that a chest injury may affect Breathing, the major effect of a tension pneumothorax and haemothorax is on Nathan Burnside Circulation. A chest drain will be both diagnostic and therapeutic. Kieran McManus Unlike penetrating injuries, most blunt chest injuries do not need immediate resuscitative surgery, but it is wrong to assume that they do not require surgical intervention at all. This presumption can Abstract result in the potential benefit of a specialist thoracic opinion being The restructuring of emergency healthcare services has led to more blunt ignored, and many injuries being undertreated. thoracic trauma being treated by a multidisciplinary team, including gen- eral, orthopaedic and trauma surgeons, often without immediate access Secondary survey to a thoracic surgeon. Having a critical mass of injured patients in a cen- tral location, it has been possible to bring expertise from other areas of When assessing chest injuries, the mechanism of trauma (Table 1) intensive care, radiology and surgery and apply new technology and tech- may be more relevant in terms of immediate injury and eventual niques to the trauma patient. We now see the regular use of endovascular outcome than the radiological images. The details of the accident stenting and embolization reducing the need for urgent surgery on unsta- are key to establishing the specific injuries that arise in connection ble patients and the increasing use of extracorporeal membranous with particular trauma situations and can often predict the late oxygenation (ECMO) to salvage patients with acute respiratory distress sequelae (Table 2).
    [Show full text]
  • Cardiac Concussion (Commotio Cordis)
    PEDIATRIC EM • PÉDIATRIE D’URGENCE Cardiac concussion (commotio cordis) Rahim Valani, MD;* Angelo Mikrogianakis, MD;† Ran D. Goldman, MD† SEE ALSO COMMENTARY, PAGE 431. ABSTRACT Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with rel- atively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presenta- tion is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation. Key words: commotio cordis; chest trauma, pediatric; defibrillation; resuscitation RÉSUMÉ Un traumatisme contondant au thorax chez les patients pédiatriques peut causer diverses lésions au myocarde. On constate une commotion cardiaque (commotio cordis) chez les patients dont la région précordiale a subi un choc relativement faible à un moment vulnérable du cycle cardiaque. Ces patients n’ont aucun problème cardiaque prédisposant et l’autopsie ne révèle aucun signe de dommages cardiaques. Sur le plan clinique, le phénomène se manifeste habituellement par un ef- fondrement immédiat secondaire à une arythmie mortelle. La prévention constitue la pierre an- gulaire de la réduction possible de l’incidence au moyen de matériel de sécurité, et peut-être, d’une défibrillation immédiate. Introduction heart damage, even at autopsy.3,4 Emergency physicians, particularly those interested in injury prevention, should be Although trauma, in general, is the leading cause of mor- familiar with cardiac concussion because its mortality rate tality in children worldwide1,2 clinically significant isolated is as high as 85% and because it is often preventable.5 blunt chest trauma in children is rare.
    [Show full text]
  • Left Subclavian Artery - Does It Need Attention During TEVAR for Blunt Traumatic Aortic Injury
    J ournal of Medical Care Research and Review JMCRR 3 (5), 359–364 (2020) ISSN (O) 2589-8949 | (P) 2589-8930 Left Subclavian Artery - Does it need attention during TEVAR for Blunt Traumatic Aortic Injury Sivakumar Krishnasamy?1, Ong Hao Siang2, Ahmad Rafizi Hariz Ramli3, Nur Adura Yaakup4, Norshazriman Sulaiman4, Ramesh Singh5, Raja Amin Raja Mokhtar1 11Division of Cardiothoracic Surgery , Department of Surgery , Faculty of Medicine , University Malaya 2Faculty of Medicine , University Malaya 3Vascular Unit , Department of Surgery, Faculty of Medicine, University Malaya 4Interventional Radiology , Department of Radiology, University Malaya 5Division of Cardiology, Department of Medicine, Faculty of Medicine , University of Malaya DOI: https://doi.org/10.15520/mcrr.v3i5.96 Accepted 2/5/2020; Received 2/4/2020; Publish Online 7/5/2020 Reviewed By: K. ABSTRACT Ahmed Ismail ElTris Introduction: Endovascular treatment for Blunt Thoracic Aortic Injury is currently an emerging alternative as compared to traditional open repair due to superior out- comes in terms of mortality and morbidity. However, the decision to revascularize the left subclavian artery remains controversial in cases requiring the coverage of the left subclavian artery. We report our experience with endovascular stent-graft repair for blunt traumatic thoracic aorta injury. Methods: Medical records from 11 patients who underwent Thoracic Endovascular Aortic Repair (TEVAR) for Blunt Thoracic Aortic Injury (BTAI) between January 2017 to April 2019 were analysed Results: Among the 11 patients who sustained BTAI, 10 of them have been caused by motor vehicle accidents with the exception of 1 patient who sustained a fall from height. The mean Injury Severity Score is 32.72.
    [Show full text]
  • Hybrid Approach for Treatment of Multiple Traumatic Injuries of the Heart, Aorta, and Abdominal Organs
    Korean J Thorac Cardiovasc Surg 2019;52:372-375 □ CASE REPORT □ ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online) https://doi.org/10.5090/kjtcs.2019.52.5.372 Hybrid Approach for Treatment of Multiple Traumatic Injuries of the Heart, Aorta, and Abdominal Organs Seon Hee Kim, M.D.1, Seunghwan Song, M.D.2, Ho Seong Cho, M.D.2, Chan Yong Park, M.D.3 1Department of Trauma and Surgical Critical Care, Pusan National University Hospital Trauma Center, Pusan National University School of Medicine and Biomedical Research Institute; 2Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan; 3Department of Trauma, Wonkwang University Hospital Trauma Center, Wonkwang University School of Medicine, Iksan, Korea A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomog- raphy was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications. Key words: 1. Trauma 2. Hybrid operation 3. Endovascular procedure/stent 4. Resuscitation 5. Shock Case report sonography for trauma (FAST) was performed and revealed fluid collection in the pericardial, pleural, A 55-year-old man was admitted to the emergency perihepatic, and peripelvic spaces.
    [Show full text]