Complications associated with pre-hospital open thoracostomies: a rapid review

Background Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax. Main findings A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases. Conclusion There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.

Injury Risks of Rear Occupant in Typical Four-door Type of Pick-up Truck under Vehicle Collision

This research explores the injury risks of occupants in four-door type of pick-up truck using experimental based collision with Hybrid III dummy for occupant injury indicators. The full-sized crash laboratory was developed to conduct full frontal impact based on standard regulation. To verify performance of full-sized crash laboratory and vehicle deceleration, low and high speed tests were conducted at the same vehicle. The Hybrid III dummy with head and chest sensors was used at the rear outboard seat during high speed test. Consequently, the deflection and thoracic viscous criteria, which represent the chest injuries, are up to 93 mm and 3.96 m/s, respectively, high beyond the standard requirement. Moreover, the most important finding of this research is that the four-door pickup truck is subjected to the 2nd impact up to 116.51 G at dummy head with higher resultant acceleration than the 1st impact (65.62 G) due to the limited space behind the rear headrest and thinner backrest of rear seat. This research also investigates the post-crash results to illustrate the suggestive idea for improving crashworthiness of future design resulting in mitigation of occupant injuries.

Clinical Features, Management, and Outcomes of Chest Trauma at a Tertiary-Care Centre in India: A Retrospective Observational Study

Introduction. Chest is one of the main sites of injuries in trauma being a part of the torso. Many important organs lie in rib cage. However, data on chest injuries are scarce. Methods. A retrospective study was carried out for chest trauma patients including polytrauma (n = 184) from hospital records for five years (2016–2020). Various parameters including demographic profile, mode of injury, management, and outcomes were studied. Results. Mean age of patients was 37 ± 16 years with a male to female ratio of 2.4 : 1. Road traffic injuries remained the most common cause of trauma followed by assaults. Most of the patients were managed conservatively (55.43%). Mortality was seen in only 1.63% patients. Conclusion. Young male patients are usually affected by trauma. Road traffic injuries are the commonest cause. However, most patients can be managed by conservative treatment and mortality is seen only in polytrauma patients in the present study.

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.

The relative importance of clinical factors in initiating interfacility transfer of major trauma patients: A discrete choice experiment

Introduction and Objectives Approximately 30% of patients meeting severe injury criteria are never transferred to lead trauma centers (LTCs). The reasons for this gap are not fully understood but involve both system-level factors and individual decision-making. We used a method called discrete choice modeling (DCM) to evaluate which clinical and demographic patient factors might make emergency physicians more likely to initiate transfers to LTCs. Methods An email survey was distributed to physicians working in emergency departments (EDs) in Ontario. The relative importance of clinical and demographic patient attributes as drivers for transfer was evaluated using DCM. Simulated patient cases were created using a random generator to combine attributes. Each respondent was presented with 36 different patients in sets of three and asked if they would transfer each patient to an LTC. The relative importance of each driver was then compared across physician characteristics. Results One hundred and fifty three emergency physicians completed the survey. The drivers for transfer, expressed as utility scores, were derangements in hemodynamics (22), CNS/head injuries (19), pelvic fractures (11), chest injuries (10), comorbidities (9), abdominal injuries (8), extremity injuries (7), mechanism of injury (7), age (5), and gender (2). Drivers for patient transfer did not differ based on physician experience or type of training. Conclusion In this DCM study, the clinical and demographic factors most likely to make emergency physicians consider patient transfers to LTCs were patient hemodynamic derangements and CNS/head injuries. Overall, these drivers did not differ by physician experience or training. An understanding of such patient-level drivers for transfers to LTCs may improve the implementation of evidence-based interfacility transfer criteria.

Thoracic surgery

This chapter discusses the anaesthetic management of thoracic surgery. It begins with general principles of thoracic surgery, including isolation of the lungs, one-lung ventilation, and providing analgesia for thoracic surgery. Surgical procedures covered include rigid bronchoscopy and bronchial stent insertion; mediastinoscopy; wedge resection; lobectomy; pneumonectomy; thoracoscopy and video-assisted thoracoscopic surgery (VATS); drainage of empyema and decortications; lung volume reduction surgery and bullectomy; repair of bronchopleural fistula; pleurectomy and pleurodesis; oesophagectomy and surgical management of chest injuries.

Prevention of injuries in sports

Purpose: to determine the causes of injuries in sports and the factors that cause them. Material and methods: study of special literature and generalization of experience of preparation of sportsmen in various kinds of sports. Analysis of factors influencing sports injuries in order to develop measures for their prevention. Results: There are a large number of injuries that can be received during sports. In our article we will consider some of them. Trauma is a lesion of the surface of the body or internal organs, which arose under the influence of external factors, as a result of which one or another organ has lost the ability to perform its function. Depending on the nature of the injured tissue, there are skin (strokes, wounds), subcutaneous (ligament ruptures, bone fractures, etc.) and abdominal (hemorrhage, chest injuries, joints) injuries. Injuries are divided into direct and indirect, depending on the point of application of force. They can be single (eg, transverse femoral fracture), multiple (multiple rib fracture), combined (pelvic fracture with rupture of the bladder) and combined (hip fracture and frostbite, etc.). Injuries are open with a violation of integrity and closed, when the replacement of tissues and organs occurs with intact skin and mucous membranes. According to the level of severity of injuries are divided into mild, moderate and severe. Injuries to the extremities are most often observed in the localization of injuries in athletes, among them injuries of the joints, especially the knee and ankle, predominate. Upper limb injuries (70.0% of all injuries) are more common during gymnastics. Most sports are characterized by injuries of the lower extremities, such as athletics and skiing (66,0 %). Head and face injuries are typical for boxers (65,0 %), fingers - for basketball players and volleyball players (80,0 %), elbow joint for tennis players (70,0 %), knee joint - for football players (48,0 %). etc. Among sports injuries, as a rule, a high percentage of injuries of medium severity. Conclusion: analysis of the causes of injuries in sports, allows us to conclude that injuries in sports can be prevented. A coach in a certain sport plays a crucial role in injury prevention. Its activities should take place in close contact with medical staff. It is the physician's responsibility to systematically record all injuries. Not only severe injuries, but also moderate injuries must be carefully studied, the causes of their occurrence must be identified and the necessary measures to eliminate them must be developed.

Effects of sedan wheelbase size on left rear-seat occupant injury risk in small offset crashes

The objective of this study was to investigate the effect of sedan wheelbase size on the kinematics and injury severity of left rear-seat occupants by using the finite element (FE) modeling method. A total of 270 cases with detailed accidental information records were analyzed to define the influence laws of wheelbase size and impact speed on the injury of left rear-seat occupants. First, the THUMS (Ver. 4.0.2) FE model was used to reconstruct two small offset collisions with different wheelbases size and unbelted left rear-seat occupants, and the effectiveness of the accident model was verified. Then, seatbelts were added to the left rear-seat occupant models. Finally, LS-DYNA software was used to study the correlation among head and chest injury and five sedan wheelbases sizes (2300, 2450, 2600, 2750, and 2905 mm) at three impact velocities (54, 64, and 74 km/h). The results showed that the occupants’ chest injuries showed an upward trend at the impact velocity of 64 and 74 km/h when the wheelbases sizes was reduced to 2300 mm. This research illustrated that at higher impact velocities, excessively small wheelbases might increase the chest injury severity of left rear-seat occupants.

EVALUATION OF THE POSSIBILITY OF USING CORYOLIS VITRATOMYER IN THE DIAGNOSIS OF PULMONARY DAMAGE IN VICTIMS WITH FIRE PENETRATION EARLY WOUNDS

Summary: The aim of the study was to determine the dependence of the volume of air discharge from the pleural cavity on the choice of surgical treatment in patients with penetrating chest injuries. Materials and methods. Of the 39 observations, video-assisted thoracoscopy (VATS) was performed in 24 patients due to existing hemothorax. Results and their discussion. Among patients with penetrating chest injuries and early complications in the form of isolated pneumothorax on the first day, VATS was performed in three cases, due to increased air discharge from the pleural cavity. On the second and third day, 3 and 1 patient needed PBX, respectively. The article presents the experience of using a Coriolis flowmeter to objectify the diagnosis of lung injuries in victims with gunshot wounds penetrating the chest. Depending on the speed and volume of air discharge from the pleural cavity, the dynamics can be determined by the tactics of treatment. Conclusions: 1. Observation in the dynamics of the rate (

TREATMENT OF THORAX TRAUMA

Summary. Aim. Improving the results of treatment of chest injuries. Materials and methods. 2112 patients with thorax trauma were treated in Lviv lung centre from 1998 to February 2021 year. Diagnosis consisted of clinical, radiological, bronchological, thoracoscopic, sonographic and computer tomography of the chest. Results and their discussion. 2112 patients (at the age of 12-87): penetrating wounding of thorax (PWT) – 501 (23,72%, including 68 wounding of heart and pericardium), closed trauma of thorax (CTT) – 1611 (76,28%); males – 1991 (94,27%), females – 121 (5,73%). 26 (5,32%) patients with PWT have died after operations, among them – 11 patients with heart wounding; and 11 (0,68%) males have died with combined CTT (7 patients with closed trauma of brain from 48 – 14,6%). Total mortality was 1,75 % (37 from 2112). Conclusions . At PWT the thoracotomy, except for urgent states, it is expedient to postpone and carry out it after stabilization of hemodynamics of the patient. Thoracoscopy is mandatory for all patients with PWT with a stable general condition. At patients with a floating segment of a chest wall of a technique of its fixing to define individually depending on a situation.