Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

Facial schwannoma: results of a large case series and review

2008 ◽  
Vol 122 (11) ◽  
pp. 1139-1150 ◽  
Author(s):  
B McMonagle ◽  
A Al-Sanosi ◽  
G Croxson ◽  
P Fagan
Keyword(s):  
Facial Nerve ◽  
Current Literature ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Treatment Algorithm ◽  
Case Series ◽  
Tertiary Referral ◽  
Management Algorithm ◽  
Facial Function ◽  
Facial Rehabilitation

AbstractObjectives and hypothesis:To report a series of 53 cases of facial schwannoma, to review the current literature, addressing contentious issues, and to present a management algorithm.Study design:Retrospective case review combined with review of current literature.Materials and methods:A review of the case notes of 53 patients with intracranial and intratemporal facial schwannoma, from two tertiary referral centres, was undertaken. This represents the largest series of facial schwannomas with clinical correlations in the literature. Data relating to epidemiological, clinical and management details were tabulated and compared with other large series. A review of the current literature was performed, and a management algorithm presented.Results:There were 23 (43 per cent) female and 30 (57 per cent) male patients. Patients' ages at presentation ranged from five to 84 years, with a mean of 49 years. Twenty-five (47 per cent) of the tumours were present on the left side and 28 (53 per cent) on the right side. Hearing loss was the most common presenting symptom, being present in 31/53 (58 per cent) patients, followed by facial weakness in 27/53 (51 per cent). Two patients (4 per cent) were completely asymptomatic, and their facial neuromas were diagnosed incidentally. The schwannoma extended along more than one segment of the facial nerve in 39 patients (74 per cent), with the mean number of segments involved being 2.5. A conservative approach of clinical observation was undertaken in 20 patients (38 per cent). Thirty-three patients (62 per cent) underwent surgery, with a total of 36 procedures. The translabyrinthine approach was most common, being utilised in 17 of the 36 procedures. Two patients underwent revision surgery for residual or recurrent disease on three occasions. There was total removal of tumour in 21 cases; the remainder had subtotal or no removal with drainage or decompression of the tumours. Twenty-one nerve reconstructions were performed, and 18 facial rehabilitation procedures were performed on 14 patients.Discussion:The results of this case series are similar to those of other reported series. The diagnosis of facial schwannoma is now generally made pre-operatively, due to improved imaging techniques and heightened awareness. Clinical assessment of facial function and imaging form the mainstays of surveillance for these tumours. These tumours are managed via clinical observation or surgical intervention; the latter can range from simple procedures (such as drainage of cystic components) to aggressive tumour removal and facial nerve reconstruction. Facial rehabilitation procedures may also be applied. The timing of intervention is contentious; surgical intervention is indicated when facial function deteriorates to a House–Brackmann grade IV level.Conclusion:Facial schwannomas are rare lesions, and reported series are generally small. Due to the complex management issues involved, these tumours are best managed in a tertiary referral setting. Observation is preferred until facial function deteriorates to a House–Brackmann grade III level, at which time surgery is considered. When facial function deteriorates to House–Brackmann grade IV, surgical intervention is indicated. We advocate surgical management based on the treatment algorithm described.

CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

2016 ◽  
Vol 82 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Andrea A. Zaw ◽  
Donovan Stewart ◽  
Jason S. Murry ◽  
David M. Hoang ◽  
Beatrice Sun ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Aortic Injury ◽  
Initial Evaluation ◽  
Whole Body ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Intravenous Contrast ◽  
Whole Body Ct ◽  
Level I

Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition. Rapid diagnosis is important to appropriately treat patients. The purpose of this study was to compare CT with intravenous contrast (CTI) to CT with angiography (CTA) in the initial evaluation of blunt chest trauma patients. This was a retrospective review of all blunt trauma patients who received a CTI or CTA during the initial evaluation at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Two-hundred and eighty-one trauma patients met inclusion criteria. Most, 167/281 (59%) received CTI and 114/281 (41%) received CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale in emergency department. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified an injury in 54 per cent compared with 46 per cent in CTA ( P = 0.05). Overall, 2 per cent of patients had BAI with similar rates in CTI and CTA (2% vs 2%, P = 0.80). BAI was not missed using either CTI or CTA. Trauma patients studied with CTI had similar diagnostic findings as CTA. CTI may be preferable to CTA during the initial assessment for possible BAI because of a single contrast injection for whole body CT.

scholarly journals Challenges of diagnosis of COVID-19 in trauma patients: A case series

Trauma ◽  
2020 ◽  
pp. 146040862095060
Author(s):  
Golnar Sabetian ◽  
Farnia Feiz ◽  
Alireza Shakibafard ◽  
Hossein Abdolrahimzadeh Fard ◽  
Sepideh Sefidbakht ◽  
...  
Keyword(s):  
Ct Scan ◽  
Trauma Center ◽  
Chest Trauma ◽  
Case Series ◽  
Chest Ct ◽  
Lung Contusion ◽  
Trauma Patients ◽  
Type B ◽  
Chest Ct Scan ◽  
Pcr Test

Background Diagnosis of COVID-19 can be challenging in trauma patients, especially those with chest trauma and lung contusion. Methods We present a case series of patients from February and March 2020 who were admitted to our trauma center at Rajaee Hospital Trauma Center, in Shiraz, Iran and had positive SARS-CoV-2 PCR test or chest CT scan suggestive of COVID-19 and were admitted to the specific ICU for COVID-19. Results Eight COVID-19 patients (6 male) with mean age of 40 (SD = 16.3) years old, were presented. All patients were cases of trauma injuries, with multiple injuries including chest trauma and lung contusion, admitted to our trauma center for management of their injuries, but they were diagnosed with COVID-19 as well. Two of them had coinfection of influenza type-B and SARS-CoV-2. All patients were treated for COVID-19 and three of them died; the rest were discharged from hospital. Conclusion Since PCR for SARS-CoV-2 is not always sensitive enough to confirm the cause of pneumonia, chest CT manifestations can be helpful, though, they are not always differentiable from lung contusion. Therefore, both the CT scan and the clinical and paraclinical presentation and course of improvement can be beneficial in diagnosing COVID-19 in the trauma setting.

Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial

2014 ◽  
Vol 30 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Edward P. Sloan ◽  
Max Koenigsberg ◽  
W. Brad Weir ◽  
James M. Clark ◽  
Robert O'Connor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blunt Trauma ◽  
Surgical Intervention ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Efficacy Trial ◽  
Estimated Blood Loss ◽  
The Us ◽  
The Mean ◽  
Blood Loss Volume

AbstractIntroductionOptimal emergent management of traumatic hemorrhagic shock patients requires a better understanding of treatment provided in the prehospital/Emergency Medical Services (EMS) and emergency department (ED) settings.Hypothesis/ProblemDescribed in this research are the initial clinical status, airway management, fluid and blood infusions, and time course of severely-injured hemorrhagic shock patients in the EMS and ED settings from the diaspirin cross-linked hemoglobin (DCLHb) clinical trial.MethodsData were analyzed from 17 US trauma centers gathered during a randomized, controlled, single-blinded efficacy trial of a hemoglobin solution (DCLHb) as add-on therapy versus standard therapy.ResultsAmong the 98 randomized patients, the mean EMS Glasgow Coma Scale (GCS) was 10.6 (SD = 5.0), the mean EMS revised trauma score (RTS) was 6.3 (SD = 1.9), and the mean injury severity score (ISS) was 31 (SD = 17). Upon arrival to the ED, the GCS was 20% lower (7.8 (SD = 5.3) vs 9.7 (SD = 6.3)) and the RTS was 12% lower (5.3 (SD = 2.0) vs 6.0 (SD = 2.1)) than EMS values in blunt trauma patients (P< .001). By ED disposition, 80% of patients (78/98) were intubated. Rapid sequence intubation (RSI) was utilized in 77% (60/78), most often utilizing succinylcholine (65%) and midazolam (50%). The mean crystalloid volume infused was 4.2 L (SD = 3.4 L), 80% of which was infused within the ED. Emergency department blood transfusion occurred in 62% of patients, with an average transfused volume of 1.2 L (SD = 2.0 L). Blunt trauma patients received 2.1 times more total fluids (7.4 L vs 3.5 L, < .001) and 2.4 times more blood (2.4 L vs 1.0 L,P< .001). The mean time of patients taken from injury site to operating room (OR) was 113 minutes (SD = 87 minutes). Twenty-one (30%) of the 70 patients taken to the OR from the ED were sent within 60 minutes of the estimated injury time. Penetrating trauma patients were taken to the OR 52% sooner than blunt trauma patients (72 minutes vs 149 minutes,P< .001).ConclusionBoth GCS and RTS decreased prior to ED arrival in blunt trauma patients. Intubation was performed using RSI, and crystalloid infusion of three times the estimated blood loss volume (L) and blood transfusion of the estimated blood loss volume (L) were provided in the EMS and ED settings. Surgical intervention for these trauma patients most often occurred more than one hour from the time of injury. Penetrating trauma patients received surgical intervention more rapidly than those with a blunt trauma mechanism.SloanEP,KoenigsbergM,WeirWB,ClarkJM,O'ConnorR,OlingerM,CydulkaR.Emergency resuscitation of patients enrolled in the US diaspirin cross-linked hemoglobin (DCLHb) clinical efficacy trial.Prehosp Disaster Med.2015;30(1):1-8.

scholarly journals Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

2021 ◽  
Keyword(s):  
High Risk ◽  
Blunt Trauma ◽  
Complication Rate ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Low Risk ◽  
Quality Data ◽  
Trauma Patients ◽  
Surgical Exploration

Context: Mesenteric and bowel injuries (MBI) are rare and dangerous presentations of blunt abdominal trauma and often cause clinical uncertainty since their diagnosis is difficult and operative treatments are often delayed. No clear guidelines exist regarding this topic, and due to the rarity of the injury, few and highly low-quality data are available. This study aimed to compare early surgical exploration, delayed surgical exploration, and non-operative management in patients with proven and suspected blunt MBI. Evidence Acquisition: Detailed research was performed on Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until 29th November 2019. The studies that were considered eligible to be included in this systematic review and consequent meta-analysis were those focusing on patients with proven MBI or computed tomography (CT) signs suspected for them and comparing early surgical exploration (EOR) with delayed one (DOR) or with selective surgical exploration (SOR) after clinical observation. The eligible studies were sub-grouped into those using a delay cut-off (to distinguish “early” and “deferred” surgical intervention) higher than 12 h and those using a cut-off lower than 12 h, as well as those focusing on patients with high-risk CT signs (pneumoperitoneum and active mesenteric bleeding) and those focusing on patients with low-risk ones. Results: Finally, 16 studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 2,702 patients. All studies, although not randomized, were considered to be at the acceptable risk of bias in the important domains. It was found that in patients with proven MBI, in the subgroup of studies with a delay cut-off for surgical intervention lower than 12 h, the complication rate was significantly lower in EOR, compared to DOR (risk ratio [RR]=0.47, 95% CI=0.29-0.79, P=0.004). In patients with suspected MBI with low-risk CT signs, the complication rate was significantly lower in SOR, compared to EOR (RR=1.79, 95% CI=1.27-2.53, P=0.001). It was also revealed that in patients with high-risk CT signs, the complication rate and the length of stay (LOS) were significantly lower in EOR, compared to DOR (complication: RR=0.38, 95% CI=0.17-0.84, P=0.02; LOS: mean difference=-12.00, 95% CI=-21.44-2.56, P=0.01). Conclusions: The present meta-analysis confirmed that in patients with proven blunt MBI a delay of surgical intervention higher than 12 h would lead to a higher complication rate and a longer LOS. Based on the results, in blunt trauma patients with pneumoperitoneum or active mesenteric bleeding at the admission CT scan, complications and LOS could be reduced by performing an early surgical exploration. On the other hand, in blunt trauma patients with low-risk CT signs of suspected MBI, a clinical observation with selective surgical exploration in case of clinical or radiological worsening could reduce the complication rate without increasing mortality and LOS.

Efficacy of serratus anterior plane block in pain control in traumatic posterior rib fractures: A case series

Trauma ◽  
2021 ◽  
pp. 146040862110467
Author(s):  
Paramvir Singh ◽  
Ashish Sakharpe ◽  
Jasmeen Kaur ◽  
Anterpreet Dua ◽  
Shvetank Agarwal ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Pain Control ◽  
Case Series ◽  
Pulmonary Complications ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Serratus Anterior ◽  
Body Habitus ◽  
Multiple Rib Fractures ◽  
Anterior Plane

Blunt trauma patients commonly present with multiple rib fractures, which increases overall morbidity and mortality due to pulmonary complications. Effective chest wall analgesia may be challenging due to positioning difficulty, body habitus, anticoagulation issues with neuraxial interventions, etc. Serratus anterior plane block has been shown to be beneficial in anterior and lateral rib fractures in recent studies. We propose the efficacy of this block in posterior rib fractures as well, through this small case series of blunt trauma patients with posterior rib fractures, reporting significant pain relief after the block.

Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

2018 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Mochamad Targib Alatas
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Intervention ◽  
Case Series ◽  
Spinal Cord Injury Patient ◽  
Traumatic Spinal Cord Injury ◽  
Best Interest ◽  
Score Improvement ◽  
Cord Injury ◽  
Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible. 

Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

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