Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
Ismail MahmoodBasil YounisKhalid AhmedFuad MustafaAyman El‐MenyarMohammad AlabdallatAshok ParchaniRubén PeraltaSyed NabirNadeem AhmedHassan Al‐Thani
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Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Conclusions: Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.Keywords:
Thoracostomy
Occult
Chest injury
Blunt trauma
Background: Chest trauma is common and its pattern varies in different places. Majority of patients are managed mainly conservatively. Tube thoracostomy is a simple procedure but it is associated with significant number of complications.The aim of this study was to evaluate the clinical pattern and its management at Muhimbili National Hospital. Methods: A hospital based prospective study of all consecutive patients admitted with chest trauma at Muhimbili National Hospital between November 2007 and September 2008. Clinical assessment and chest x-ray findings were used to diagnose and to evaluate any complications associated with chest tubes using a structured questionnaire. Results: The majority (95/119) of patients were males. Their age ranged from 12 to 72 years with the mode of 32years. Motor traffic injury (MTI) was the commonest cause of chest trauma accounting for 72.3% of the cases. Rib fractures were the most clinical type of chest injury and accounted for about 42.9% of cases. Blunt chest injuries were more common (75.6%) than penetrating injuries. Seventy three (61.3%) patients had other associated injuries, in which fracture of extremities (25.2%) and head injury (21.8%) were the commonest. Sixty seven (56.3%) patients were treated with closed tube thoracostomy only. The overall complication rate of the chest tubes was 32.9% of which infection (24.7%) and Nonfunctional tubes (17.4%) were the commonest. High mortality rate of 24.2% was recorded. Conclusion: The clinical pattern and the management of chest injuries in this study was similar with many other series of study, however, the rate of closed tube thoracostomy remained high with many and avoidable complications.
Thoracostomy
Chest injury
Chest tube
Thorax (insect anatomy)
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Thoracic injuries account for 20-25% of deaths due to trauma and contribute to 25-50% of the remaining deaths. Approximately 16,000 deaths per year in the United States alone are attributable to chest trauma. The present study was done in Dhaka Medical College Hospital from January 2004 to September 2005. This is one of the specialized Institutes of this country dealing with chest injury. In this series, 50 cases of penetrating chest injury were studied and 12 (Twelve) of them had also associated with blunt chest injury. The highest incidence occurred between the ages of 31 and 50 yrs. Male was predominantly affected by penetrating chest injury i.e. 84%. Homicidal injury was common in rural areas but accidental injury was common in urban area. Injuries by sharp weapon caused all of the homicidal injuries. In 28 cases (56%) showed penetrating chest injury with severe respiratory distress and rest 10 (20%) cases showed penetrating chest injury with hemorrhage from external wounds. Here, 70% cases are managed conservatively with or without I.C Tube drainage. Mean duration of Hospital stay for patient treated conservatively with or without 1C tube thoracostomy was 8 days but in patient with major surgery it was 15.5 days. Range of Hospital stay for conservatively treated patient was (3--8 days) and for patient with major surgery it was (10—16 days). Referred to other centers had due to extra--pulmonary Involvement, after initial resuscitation & I.C. tube thoracostomy. Mortality:-2% for penetrating chest injury.
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Accidental
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Hemothorax
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Hemothorax after blunt trauma results from injury to intrathoracic structures or the chest wall. Tube thoracostomy is the most common mode of treatment; depending on the type of injury, it is frequently the only intervention required. Rarely, blunt cardiac injury can produce hemothorax if a communication exists between the pericardium and pleural space. We describe such a case that highlights the importance of a broad differential diagnosis when treating acutely injured patients.
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Blunt neck trauma is a rare event, accounting for only 5-10% of all trauma to the neck. It occurs most commonly following motor vehicle accidents, although clothesline mechanisms and strangulation can also cause blunt injury to the aerodigestive tract and cervical vasculature. The most common mechanism for blunt neck trauma, motor vehicle accidents, typically occurs due to impact with the steering column or dashboard. Blunt trauma patients in extremis with obvious airway compromise should be emergently intubated with a well-thought-out rescue plan in case direct or video laryngoscopy is unsuccessful. Patients with blunt neck trauma can have airway, vascular, and esophageal injuries. While esophageal injuries are extremely rare and airway injuries are typically apparent or easily evaluated by direct visualization in patients stable enough for bronchoscopy, the evaluation of blunt cerebrovascular injury is much more controversial.
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Introduction/Objective. Ocular trauma is a globally important cause of visual impairment. The aim of our study was to analyses demographic, epidemiological, and clinical characteristics of blunt ocular trauma. Methods. The retrospective study enrolled patients with blunt ocular trauma, hospitalized at the Eye Clinic, University Clinical Centre of Serbia in Belgrade during a four-year period (2018?2022). Demographic characteristics, mechanism of injury, best corrected visual acuity on admission and discharge and injured eye structure were analyzed. Results. Out of 283 patients, the majority (n = 233, 82%) were men. People aged 61 and over (n = 82, 29%) were at greatest risk for blunt ocular trauma. Injuries from splitting wood (n = 78, 28%) and various blunt tools and objects (n = 70, 25%) were the most common mechanism in the entire study group, both in men and in women. Visual acuity on admission was better than 0.6 in 147 (52%) patients and at discharge in 185 (65%). The most common eye structure affected are pathological findings in anterior chamber (n = 160, 56%), which are mainly related to hyphemia. Conclusion. Present study showed that blunt ocular trauma affects all age groups, but most often elderly and children. Men are injured more often than women. Splitting wood and manipulating blunt tools and objects are activities with the highest risk of blunt ocular trauma.
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Tension pneumothorax is a life-threatening medical emergency mostly associated with chest trauma. It is considered a leading cause of death due to injury and represents a substantial portion of potentially preventable deaths in the battlefield. The accepted therapeutic approach is manual thoracostomy with chest tube insertion. This is a relatively simple procedure when performed by skilled hands and in optimal conditions. In the battlefield and in other pre-hospital settings or when performed by unprofessional personnel, it may become complicated and time-consuming. We describe a novel technique for the treatment of pneumothorax in the pre-hospital setting, utilizing a quick, one-handed, easy-to-apply approach.
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Chest injury
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Thoracic cavity
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Chest injury
Hemothorax
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Poster: ECR 2018 / C-0272 / Blunt force trauma resulting in mixed blunt and penetrating trauma injury patterns to the carotid artery: a literature review, illustratory case report, archive of imaging findings and the discussion of utility of 3D CT reformats for peri-operative surgical planning by: S. M. Crilly 1, E. McElroy2, J. Ryan3, L. Lawler3; 1Perth, WA/AU, 2Perth/AU, 3Dublin/IE
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Penetrating Trauma
GUNSHOT INJURY
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