DOI: http://dx.doi.org/10.18203/2349-2902.isj20214006

Single institutional experience of management of penetrating trauma chest

Niranjan Ulhasrao Jadhav, Subrata Pramanik, Ridhika Munjal, Anubhav Gupta, Anirudh Mathur, Peeyush Kesharwani

Abstract


Chest trauma is now the second most common non-intentional traumatic injury. Chest trauma is associated with high mortality. Control of blood loss and stabilization of vital organs is of vital importance over diagnostic and therapeutic measures. Bleeding may arise from chest wall, intercostal or internal mammary arteries, great vessels, mediastinum, myocardium, lung parenchyma, diaphragm or abdomen. Modified early warning signs (MEWS) score of >9 on presentation have shown higher rate of mortality. Diagnostic modalities such as extended-focused assessment with sonography in trauma (eFAST) have been effective. The type of surgical approach alters according to the site of injury. We here presented our experience with six such patients. All the six patients involved in this study had penetrating trauma chest with various sharp weapons including dagger, ice pick, flag post. Time of presentation of all these patients were delayed due to ours being a tertiary centre. The patients were explored on the basis of eFAST findings, intercostal drainage, hemodynamics. Out of the six patients two patients succumbed and the patients who died also had high MEWS score. All the patients were approached surgically with respect to the type of injury sustained. Penetrating chest trauma present a challenging clinical situation which warrants early evaluation and intervention. The cases of chest trauma then be it blunt or penetrating should always be treated within the advanced trauma life support (ATLS) guidelines followed by the definitive management. Regardless of any penetrating object, the foreign body should be left in situ and only to be removed under vision. If in case the penetrating object has already been removed the operative intervention is decided on the amount of drainage. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Hence, the operative exploration of the chest in penetrating chest trauma and should be done on emergent basis as the mechanism of injury, vital organ damage and hemodynamic status all equate to higher rate of mortality.


Keywords


Penetrating trauma chest, Hemothorax, eFAST, MEWS score, Thoracotomy, ATLS

Full Text:

PDF

References


Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis. 2017;9(3):172-7.

Mumtaz U, Zahur Z, Raza MA, Mumtaz M. Ultrasound and supine chest radiograph in road traffic accident patients: a reliable and convenient way to diagnose pleural effusion. J Ayub Med Coll Abbottabad. 2017;29(4):587-90.

Gomez LP, Tran VH. Hemothorax. Treasure Island (FL): StatPearls Publishing; 2021.

Millham FH, Grindlinger GA. Survival determinants in patients undergoing emergency room thoracotomy for penetrating chest injury. J Trauma. 1993;34(3):332-6.

Eder F, Meyer F, Huth C, Halloul Z, Lippert H. Penetrating abdomino-thoracic injuries: report of four impressive, spectacular and representative cases as well as their challenging surgical management. Pol Przegl Chir. 2011;83(3):117-22.

Jain A, Waseem M. Chest trauma. Treasure Island (FL): StatPearls Publishing; 2020.

Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975-9.

Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;33(5):1425-33.

Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177-83.

Checchi KD, Calvo RY, Badiee J, Rooney AS, Sise CB, Sise MJ, et al. Association of trauma center level and patient volume with outcomes for penetrating thoracic trauma. J Surg Res. 2020;30:442-8.

Jarman MP, Castillo RC, Carlini AR, Kodadek LM, Haider AH. Rural risk: geographic disparities in trauma mortality. Surgery. 2016;160(6):1551-9.

Küçük MP, Küçük AO, Aksoy İ, Aydın D, Ülger F. Prognostic evaluation of cases with thoracic trauma admitted to the intensive care unit: 10-year clinical outcomes. Ulus Travma Acil Cerrahi Derg. 2019;25(1):46-54.

Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis. 2017;9(3):172-7.

Sobnach S, Nicol A, Nathire H, Kahn D, Navsaria P. Management of the retained knife blade. World J Surg. 2010;34(7):1648-52.

Kundal VK, Debnath PR, Meena AK, Shah S, Kumar P, Sahu SS, et al. Pediatric thoracoabdominal trauma: experience from a tertiary care center. J Indian Assoc Pediatr Surg. 2019;24(4):264-27.

Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000;190(3):288-98.

Ekpe EE, Eyo C. Determinants of mortality in chest trauma patients. Niger J Surg. 2014;20(1):30-4.

Seamon MJ, Haut ER, Van AK, Barbosa RR, Chiu WC, Dente CJ et al. An evidence-based approach to patient selection for emergency department thoracotomy. J Trauma Acute Care Surg. 2015;79(1):159-73.