Predictors for Survival of Penetrating Trauma Using Emergency Department Thoracotomy in an Urban Trauma Center: The Cardiac Instability Score

2010 ◽  
Vol 102 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Suryanarayana Siram ◽  
Tolulope Oyetunji ◽  
Shaneeta M. Johnson ◽  
Amal L. Khoury ◽  
Patricia M. White ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Penetrating Trauma ◽  
Emergency Department Thoracotomy

scholarly journals Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Julian J Owen ◽  
Niv Sne ◽  
Angela Coates ◽  
Peter K Channan
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Trauma Patients ◽  
National Guidelines ◽  
Emergency Department Thoracotomy ◽  
Life Saving ◽  
Record Review

AbstractObjectiveEmergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines.MethodsRetrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge.ResultsOver a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines.ConclusionsSurvival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications.

scholarly journals Patterns of Pediatric Thoracic Penetrating Injuries: a Single Trauma Center Experience – Riyadh, Saudi Arabia

2020 ◽  
Author(s):  
Suliaman Alaqeel ◽  
Abdulaziz Howsawi ◽  
Mohammad Al Namshan ◽  
Jamila Al Maary
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Pediatric Trauma ◽  
Penetrating Trauma ◽  
Esophageal Injury ◽  
Common Mechanism ◽  
Thoracic Injuries ◽  
Penetrating Injuries ◽  
Number Of Patients ◽  
Major Vessel

Abstract Background Trauma in pediatric age group is a major cause of morbidity and mortality. The causes and magnitude of pediatric trauma differs from region to region. Many studies have focused on blunt injuries but not on penetrating trauma. Our aim is to identify the patterns, and outcome of pediatric thoracic penetrating injuries in a single trauma center. Methods We conducted a retrospective chart review of pediatric patients who presented with thoracic penetrating injuries from the year 2001 till 2016 in a level 1 trauma center. Patients aged 18 years or less who presented to our emergency department with thoracic penetrating injury were included. Those transferred from other institutions were excluded Results The total number of patients included with penetrating thoracic injuries were 89. Mean age was 15.5 years. One female the rest were males. The most common mechanism of injury is stab wound by knives in 80%, then Gunshot in 12%. Main mode of transport to emergency department was by private vehicles in 75.3%. Type of injuries sustained were pneumothorax 70.7%, hemothorax 25.8%, diaphragmatic injury 5.6%, hemopericardium 4.49%, lung contusion and laceration 7.8%, cardiac injury 4.49%, major vessel injury 3.4%, pneumomediastinum 2.2%, esophageal injury 1.1%, and rib Fractures 1.1%. In the emergency department, endotracheal intubation required in 13.5%, chest tube insertion 73%, blood transfusion for resuscitation 16.8%, emergency thoracotomy 2.2%, pericardiocentesis 1.1%. Surgical intervention was required in 17%. Mean length of hospital stay 3.87 days ± 4.86 SD. 93% of patients did not require intensive care unit admission. Mortality was observed in 3.4% were all had injuries to either heart, aorta or inferior vena cava. Conclusion In our institution, thoracic injuries were found uncommon and represent 25% of all penetrating trauma. Most sustained penetrating thoracic injuries can be managed nonoperatively safely. However, prompt resuscitation and intervention are required to identify and manage life-threatening ones.

scholarly journals Multidisciplinary Approach for the Management of Complex Hepatic Injuries AAST-OIS Grades IV—V: A Prospective Study

2007 ◽  
Vol 96 (3) ◽  
pp. 214-220 ◽  
Author(s):  
J. A. Asensio ◽  
P. Petrone ◽  
L. Garcí-Núñez ◽  
B. Kimbrell ◽  
E. Kuncir
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Loss ◽  
Blood Cells ◽  
Multidisciplinary Approach ◽  
Stepwise Logistic Regression ◽  
Packed Red Blood Cells ◽  
Emergency Department Thoracotomy ◽  
Estimated Blood Loss ◽  
Hepatic Injuries

Background: Complex hepatic injuries grades IV—V are highly lethal. The objective of this study is to assess the multidisciplinary approach for their management and to evaluate if survival could be improved with this approach. Study Design: Prospective 54-month study of all patients sustaining hepatic injuries grades IV—V managed operatively at a Level I Trauma Center. Main outcome measure: survival. Statistical analysis: univariate and stepwise logistic regression. Results: Seventy-five patients sustained penetrating (47/63%) and blunt (28/37%) injuries. Seven (9%) patients underwent emergency department thoracotomy with a mortality of 100%. Out of the 75 patients, 52 (69%) sustained grade IV, and 23 (31%) grade V. The estimated blood loss was 3,539±-3,040 ml. The overall survival was 69%, adjusted survival excluding patients requiring emergency department thoracotomy was 76%. Survival stratified to injury grade: grade IV 42/52–81%, grade V 10/23–43%. Mortality grade IV versus V injuries (p <0.002; RR 2.94; 95% CI 1.52–5.70). Risk factors for mortality: packed red blood cells transfused in operating room (p=0.024), estimated blood loss (p<0.001), dysryhthmia (p<0.0001), acidosis (p=0.051), hypothermia (p=0.04). The benefit of angiography and angioembolization indicated: 12% mortality (2/17) among those that received it versus a 36% mortality (21/58) among those that did not (p=0.074; RR 0.32; 95% CI 0.08–1.25). Stepwise logistic regression identified as significant independent predictors of outcome: estimated blood loss (p=0.0017; RR 1.24; 95% CI 1.08–1.41) and number of packed red blood cells transfused in the operating room (p=0.0358; RR 1.16; 95% CI 1.01–1.34). Conclusions: The multidisciplinary approach to the management of these severe grades of injuries appears to improve survival in these highly lethal injuries. A prospective multi-institutional study is needed to validate this approach.

Emergency department thoracotomy

1982 ◽  
Vol 11 (8) ◽  
pp. 413-416 ◽  
Author(s):  
Timothy C. Flynn ◽  
Richard E. Ward ◽  
Priscilla W. Miller
Keyword(s):  
Emergency Department ◽  
Emergency Department Thoracotomy

Technique of Cross-Clamping of Descending Thoracic Aorta During Emergency Department Thoracotomy

2021 ◽  
pp. 000313482110234
Author(s):  
Elias Degiannis ◽  
Konstantinos Degiannis ◽  
Dietrich Doll
Keyword(s):  
Emergency Department ◽  
Thoracic Aorta ◽  
Medical Staff ◽  
Descending Thoracic Aorta ◽  
Emergency Department Thoracotomy

Cross-clamping of the descending thoracic aorta is one of the operative maneuvers, that can be necessitated in an Emergency Department Thoracotomy and it is important for the Emergency Department medical staff to theoretically familiarize itself with its technique before need arises.

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