Chest ultrasonography by frontline physicians is more sensitive than CXR for diagnosing pneumothorax in trauma patients

2020 ◽  
Vol 173 (10) ◽  
pp. JC58
Author(s):  
Gregory Hall
Keyword(s):  
Trauma Patients ◽  
Chest Ultrasonography

scholarly journals Diaphragmatic injuries, a retrospective analysis of 50 patients

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Amer Bilal ◽  
Salim M ◽  
Tahira Nishtar ◽  
Shoaib Nabi ◽  
Muslim M ◽  
...  
Keyword(s):  
Diaphragmatic Injury ◽  
Diagnostic Methods ◽  
Organ Injury ◽  
Surgical Approaches ◽  
Medical Institute ◽  
Management Approach ◽  
Trauma Patients ◽  
Chest Ultrasonography ◽  
Space Problem ◽  
Diaphragmatic Repair

Objective:: This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment of diaphragmatic injuries in our trauma patients. Design:: An observational descriptive study. Place and duration of study:: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from March 2001 to April 2005. Subjects and methods: In this retrospective study, 50 patients admitted to our department with diaphragmatic injury were evaluated according to the type of injury, diagnostic methods, associated organ injury, treatment, modality, morbidity and mortality. Results: The average age of patients was 32 years. There were 35 (70%) male and 15 (30%0 female patients, 38 (76%) of these patients sustained blunt and 12 (24%) had penetrating chest injury. The diaphragmatic injury was right sided in 4 and left sided in 46 patients. Thirty nine (78%) patients presented in respiratory distress within 48 hours of in jury while 11 (22%) presented with bowel obstructive symptoms months and years after injury. A chest x-ray on admission suggested the diagnosis in 70% of the cases while chest ultrasonography and contrast studies were required in others. Surgery was emergent in 35 (70%), semi-emergent in 9 (18%) and effective in 6 (12%) cases. Surgical approaches were left thoracotomy (40 patients), left thoracolaprotomy (6 patients) and right thoracotomy (4 patients). The diaphragmatic repair was achieved by direct suture in 45 cases while prolene Mesh was required in 5 cases. The mortality rate was 6% (n = 3). Recurrence occurred in one (2%), wound infection in 3 (6%), pleural, space, problem in 1 and chest infection in 2 (4%) patients. Conclusion: A high index of suspicion and early surgical treatment determine the successful management of traumatic diaphragmatic injury with or without the herniation of abdominal organs. The surgical approach is individualized. We prefer the thoracic approach adding laporotomy when necess ary.

Venous thromboembolism in a general hospital. An update with low molecular weight heparin prophylaxis

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 17-22
Author(s):  
Schulz ◽  
Kesselring ◽  
Seeberger ◽  
Andresen
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Low Molecular Weight ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Hospital Stays ◽  
Event Rates

Background: Patients admitted to hospital for surgery or acute medical illnesses have a high risk for venous thromboembolism (VTE). Today’s widespread use of low molecular weight heparins (LMWH) for VTE prophylaxis is supposed to have reduced VTE rates substantially. However, data concerning the overall effectiveness of LMWH prophylaxis is sparse. Patients and methods: We prospectively studied all patients with symptomatic and objectively confirmed VTE seen in our hospital over a three year period. Event rates in different wards were analysed and compared. VTE prophylaxis with Enoxaparin was given to all patients at risk during their hospital stay. Results: A total of 50 464 inpatients were treated during the study period. 461 examinations were carried out for symptoms suggestive of VTE and yielded 89 positive results in 85 patients. Seventy eight patients were found to have deep vein thrombosis, 7 had pulmonary embolism, and 4 had both deep venous thrombosis and pulmonary embolism. The overall in hospital VTE event rate was 0.17%. The rate decreased during the study period from 0.22 in year one to 0,16 in year two and 0.13 % in year three. It ranged highest in neurologic and trauma patients (0.32%) and lowest (0.08%) in gynecology-obstetrics. Conclusions: With a simple and strictly applied regimen of prophylaxis with LMWH the overall rate of symptomatic VTE was very low in our hospitalized patients. Beside LMWH prophylaxis, shortening hospital stays and substantial improvements in surgical and anasthesia techniques achieved during the last decades probably play an essential role in decreasing VTE rates.

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