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2020, ARC Journal of Surgery
TPT may be said to occur when a one-way valve communicates with the pleural space. Air is forced into the plural space with no way to escape, eventually collapsing the affected lung. Ultimately, pushesthe mediastinum to the opposite side, decreasing venous return and comprising the opposite lung (Figure 4-1).Tension pneumothorax is considered a lifethreatening emergency condition and requires rapid recognition and treatment.
Journal of the Obafemi Awolowo University Medical Students’ Association, 2021
Chest injuries being either due to blunt and, or penetrating trauma, can cause death during the first minutes or hours after trauma and often are associated with bleeding with injuries interfering with respiration, circulation and, or both. Penetrating trauma is always surgically treated and the foreign body is removed in the operating room (OR). Life-threatening conditions, such as tension pneumothorax have to be treated by thorax drainage prior to hospital admission. Patients requiring emergency thoracotomy are either in shock or have life threatening injuries and, as expected, have significant mortality and morbidity. Patients may present with a simple dyspnea or even respiratory arrest. Adequate pain control in chest trauma is sometimes the most basic and best treatment and with a definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods and after the Primary and Secondary survey, constant reevaluation of the patient ensures that new findings are not overlooked.
Balkan Military Medical Review, 2010
The aim of this study is to assess the safety of conservative management modalities in patients with traumatic pneumothorax (PTX). Materials and Methods: We retrospectively analyzed the records of 128 patients with the diagnosis of PTX and hemopneumothorax (HPTX) due to chest trauma between 2002 and 2007. The mechanism of trauma, the treatment modality, the size of PTX (we define small PTX less than 20% of thoracic volume) pulmonary and extra pulmonary injuries, and the number of rib fractures were analyzed. Results: There were 97 male and 31 female trauma patients whose age ranged from 16 to 77. The mechanism of injury was blunt trauma in 60 patients and penetrating trauma in 68 patients. Pulmonary complications were PTX in 71, hemopneumothorax (HPTX) in 57 patients. Forty seven patients with chest trauma had associated rib fractures .Thirty three (25.8%) injuries were treated initially without chest tube drainage. Four of these 33 patients subsequently had chest drain application because of asymptomatic enlargement of the pneumothorax size on chest radiography during the follow up period. None of the remaining 29 patients deteriorated clinically during conservative treatment. Conclusions: This study demonstrates that most traumatic small PTX can be safely managed without the surgical approach of chest tube drainage.
Qatar Medical Journal
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 ¼ 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n ¼ 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.
Ulus Travma Acil Cerrahi Derg, 2018
BACKGROUND: Bilateral pneumothorax (BPTx) can be a cause of mortality as tension PTx especially in severe multi-trauma patients. The purpose of this study was to analyze incidence, morbidity, mortality and associated factors of BPTx in multi-trauma patients in order to point out importance of management, complications, morbidity and mortality.
International Archives of Medicine, 2011
Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.
European Journal of Trauma and Emergency Surgery
Traumatic tension pneumothorax (TPTX) is a life threatening condition, but literature describing this condition specifically in developing countries is scarce. We conducted a retrospective review of 115 patients with a TPTX, managed over a 4-year period in a high volume trauma service in South Africa. A total of 118 TPTXs were identified in 115 patients. Eighty-nine percent (102/115) were males, and the mean age was 26 years (SD ± 6 years). Seventy-four percent (87/118) of all TPTXs occurred on the left side. The mechanisms of injury were penetrating in 71 % (82/115) [82 stab injuries], and blunt in 29 % (33/115) [31 road traffic accidents and 2 assaults]. Ninety-seven percent (111/115) of patients presented directly to our unit, while 3 % (4/115) were referrals from other hospitals. Fifteen percent (17/115) of needle decompressions were performed in the pre-hospital setting while the remaining 85 % (98/115) were performed on arrival (73 were recognised clinically and 25 were not). ...
Annals of emergency medicine, 2018
Although traditional teachings in regard to pneumothorax and hemothorax generally recommend chest tube placement and hospital admission, the increasing use of chest computed tomography (CT) in blunt trauma evaluation may detect more minor pneumothorax and hemothorax that might indicate a need to modify these traditional practices. We determine the incidence of pneumothorax and hemothorax observed on CT only and the incidence of isolated pneumothorax and hemothorax (pneumothorax and hemothorax occurring without other thoracic injuries), and describe the clinical implications of these injuries. This was a planned secondary analysis of 2 prospective, observational studies of adult patients with blunt trauma, NEXUS Chest (January 2009 to December 2012) and NEXUS Chest CT (August 2011 to May 2014), set in 10 Level I US trauma centers. Participants' inclusion criteria were older than 14 years, presentation to the emergency department (ED) within 6 hours of blunt trauma, and receipt of...
Indian Journal of Thoracic and Cardiovascular Surgery, 2015
Background Injuries are one of the leading causes of morbidity and mortality around the world, and their burden is expected to rise dramatically by the year 2020. Tube thoracostomy is the most widely performed procedure for management of blunt and penetrating chest traumas and has a pivotal role in their management. Chest tube (Ct) drain output is the main determinant in the management and removal of chest tube. The present study was conducted to correlate drainage volume with timing of chest tube removal, with an aim to establish a safe drainage volume for chest tube removal. Materials and methods This study was conducted after ethical clearance in a tertiary care hospital on 150 patients of blunt thoracic trauma who underwent tube thoracostomy for hemopneumothorax between August 2011 and December 2012. Patients were planned for sequence randomization in three groups, viz. group A, group B, and group C, in which chest tubes were planned to be removed at a drainage output of 50 ml in group A, 100 ml drainage output in group B, and 150 ml drainage output in group C, with 50 patients in each group. Result Rate of re-accumulation after chest tube removal did not differ significantly among the three groups (p>0.05). Total significant re-accumulation rate (for which aspiration was required) was 5.8 % in group A, 5.7 % in group B, and 5.8 % in group C, respectively Conclusion Drainage volume of 150 ml at the time of chest tube removal has no impact on re-accumulation and is not associated with any increase in morbidity. It is associated with a shorter hospital stay. Keywords Thoracic trauma. Tube thoracostomy. Chest tube output Materials and methods This study was conducted after ethical clearance in a tertiary care hospital on 150 patients of blunt thoracic trauma who underwent tube thoracostomy for hemopneumothorax between August 2011 and December 2012. Patients with penetrating thoracic injury, those requiring thoracotomy, patients
International Journal of Emergency Medicine, 2011
This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process. Figure 2 Anatomical relationship of abdominal, thoracic and cervical fascial planes. A) Anatomical relationship of the cervical and thoraco-abdominal region B) Air can diffuse through cervical, mediastinal and retroperitoneal region.
Critical Care Research and Practice
Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in ...
Annals of translational medicine, 2015
The pneumothorax is an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall. Like pleural effusion where a large abnormal concentration of fluid (>100 mL) is liquid buildup in that space, pneumothorax may interfere with normal breathing. A medical term that it is used is the collapsed lung, although that term may also refer to atelectasis. There are two major types of pneumothorax; there is one that occurs without an apparent cause and in the absence of significant lung disease, while the so called; "secondary" pneumothorax occurs in the presence of existing lung pathology. In a minority of cases, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue, leading to a third type of pneumothorax, called "tensioned".
Resuscitation, 2007
Resuscitation, 2010
Study objective: Occult pneumothorax (OPTX) is defined as a pneumothorax seen on computed tomography but not apparent on supine plain radiography. Though increasingly common, the acute management of OPTX after trauma remains controversial. This evidence-based review evaluates the existing evidence regarding the safety and efficacy of observation as compared to tube thoracostomy (TT) for management of OPTX in emergency department trauma patients. Methods: The authors searched MEDLINE, EMBASE, the Cochrane Library, and other databases. Inclusion criteria: studies of adult or pediatric trauma victims at first presentation after blunt or penetrating injury (population), randomized to observation (intervention) or TT (comparison). Studies that enrolled patients on positive pressure ventilation were included but those that enrolled hemodynamically unstable patients were excluded. Outcomes of interest included progression of OPTX, mortality, complications (pneumonia, empyema), and length of stay in hospital and intensive care unit (ICU). Results: A total of 411 articles were identified. After applying the inclusion/exclusion criteria, 3 randomized trials enrolling a total of 101 patients were found to have acceptable quality standards suitable for analysis. The included studies did not reveal any significant difference between observation and TT in regards to progression of OPTX, risk of pneumonia, or length of stay in hospital or ICU. Mortality risk and empyema rate were also not different in the single studies that reported those outcomes. Conclusion: The existing evidence leads to the conclusion that observation is at least as safe and effective as tube thoracostomy for management of occult pneumothorax.
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2018
This change to the Tactical Combat Casualty Care (TCCC) Guidelines that updates the recommendations for management of suspected tension pneumothorax for combat casualties in the prehospital setting does the following things: (1) Continues the aggressive approach to suspecting and treating tension pneumothorax based on mechanism of injury and respiratory distress that TCCC has advocated for in the past, as opposed to waiting until shock develops as a result of the tension pneumothorax before treating. The new wording does, however, emphasize that shock and cardiac arrest may ensue if the tension pneumothorax is not treated promptly. (2) Adds additional emphasis to the importance of the current TCCC recommendation to perform needle decompression (NDC) on both sides of the chest on a combat casualty with torso trauma who suffers a traumatic cardiac arrest before reaching a medical treatment facility. (3) Adds a 10-gauge, 3.25-in needle/ catheter unit as an alternative to the previously...
The Journal of Emergency Medicine, 2008
... Titre du document / Document title. PNEUMOTHORAX IN A BLUNT TRAUMA PATIENT. Auteur(s) / Author(s). YIADOM Maame Yaa AB ; PLATZ Elke ; BROWN David FM ; NADEL Eric S. ; Revue / Journal Title. The Journal of emergency ...
Chest, 2008
Background: The role of chest ultrasonography (US) in the diagnosis of pneumothorax (PTX) has been established, but how it compares with lung CT scanning in the diagnosis of radiooccult PTX and in the determination of its topographic extension has not yet been completely evaluated. Objective: To determine the diagnostic accuracy of chest US in the emergency department (ED) in the diagnosis of occult PTX in trauma patients and to define its ability to determine PTX extension. Design: An 18-month prospective study. Patients: A total of 109 conscious, spontaneously breathing patients who had been admitted to the ED for chest trauma or polytrauma. Methods: All eligible patients underwent a standard anteroposterior supine chest radiograph (Rx) and a spiral CT lung scan within 1 h of ED admission. Lung US was carried out by an operator who was unaware of the other examination results, both for diagnosis and for the quantitative delimitation of the PTX. Results: Twenty-five traumatic PTXs were detected in the 218 hemithoraxes (109 patients; 2 patients had a bilateral PTX) evaluated by spiral CT scan; of these, only 13 of 25 PTXs (52%) were revealed by chest Rx (sensitivity, 52%; specificity, 100%), while 23 of 25 PTXs (92%) were identified by lung US with one false-positive result (sensitivity, 92%; specificity, 99.4%). In 20 of 25 cases, there was agreement on the extension of the PTX between CT lung scan and lung US with a mean difference of 1.9 cm (range, 0 to 4.5 cm) in the localization of retroparietal air extension; chest Rx was not able to give quantitative results. Conclusions: Lung US scans carried out in the ED detect occult PTX and its extension with an accuracy that is almost as high as the reference standard (CT scanning).
Canadian Journal of Surgery, 2015
Background: Point of injury needle thoracostomy (NT) for tension pneumothorax is potentially lifesaving. Recent data raised concerns regarding the efficacy of conventional NT devices. Owing to these considerations, the Israeli Defense Forces Medical Corps (IDF-MC) recently introduced a longer, wider, more durable catheter for the performance of rapid chest decompression. The present series represents the IDF-MC experience with chest decompression by NT. Methods: We reviewed the IDF trauma registry from January 1997 to October 2012 to identify all cases in which NT was attempted. Results: During the study period a total of 111 patients underwent chest decompression by NT. Most casualties (54%) were wounded as a result of gunshot wounds (GSW); motor vehicle accidents (MVAs) were the second leading cause (16%). Most (79%) NTs were performed at the point of injury, while the rest were performed during evacuation by ambulance or helicopter (13% and 4%, respectively). Decreased breath sounds on the affected side were one of the most frequent clinical indications for NT, recorded in 28% of cases. Decreased breath sounds were more common in surviving than in nonsurviving patients. (37% v. 19%, p < 0.001). A chest tube was installed on the field in 35 patients (32%), all after NT. Conclusion: Standard NT has a high failure rate on the battlefield. Alternative measures for chest decompression, such as the Vygon catheter, appear to be a feasible alternative to conventional NT. Contexte : La thoracotomie à l'aiguille (TA) pour le pneumothorax sous tension sur les lieux mêmes du traumatisme peut sauver des vies. Des données récentes ont mis en doute l'efficacité des dispositifs de TA classiques. C'est pourquoi le corps médical de l'armée israélienne (CMAI) a récemment proposé un cathéter plus long, plus large et plus résistant pour décomprimer rapidement le pneumothorax. Le présent article résume l'expérience du CMAI en matière de décompression des pneumothorax au moyen de la TA. Méthodes : Nous avons passé en revue le registre des traumatismes de l'armée israélienne entre janvier 1997 et octobre 2012 pour relever tous les cas où une TA a été tentée. Résultats : Durant la période de l'étude 111 patients en tout ont subi une décompression à l'aide d'une TA. La plupart des cas (54 %) résultaient de blessures par balles; les accidents de la route venaient au second rang (16 %). La plupart (79 %) des TA ont été effectuées sur les lieux, tandis que les autres ont été effectuées durant l'évacuation par ambulance ou par hélicoptère (13 % et 4 %, respectivement). L'atténuation des bruits respiratoires du côté affecté était l'une des indications cliniques les plus fréquentes de la TA, enregistrée dans 28 % des cas. L'atténuation des bruits respiratoires était plus fréquente chez les patients qui ont survécu (37 % c. 19 %, p < 0,001). Un drain thoracique a été installé sur le terrain chez 35 patients (32 %), à chaque fois après une TA. Conclusion : La TA standard s'accompagne d'un taux d'échec élevé sur le champ de bataille. Une autre mesure de décompression, comme le cathéter Vygon, semble être une solution de rechange envisageable à la TA classique.
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