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Thoracic Surgery for Gunshot Injuries

The document discusses when a thoracic surgeon should be involved in treating a thoracic gunshot injury. The Advanced Trauma Life Support guideline recommends involvement for significant blood loss, hemoptysis, subcutaneous emphysema, air leakage from chest tubes, uncertain imaging findings, or injury to the heart or large blood vessels. Surgical techniques discussed include tube thoracotomy to drain pneumothoraces or hemothoraces, thoracotomy for unstable patients or uncontrolled bleeding, and video-assisted thoracoscopy for stable patients or issues like persistent hemorrhage or air leakage.

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59 views8 pages

Thoracic Surgery for Gunshot Injuries

The document discusses when a thoracic surgeon should be involved in treating a thoracic gunshot injury. The Advanced Trauma Life Support guideline recommends involvement for significant blood loss, hemoptysis, subcutaneous emphysema, air leakage from chest tubes, uncertain imaging findings, or injury to the heart or large blood vessels. Surgical techniques discussed include tube thoracotomy to drain pneumothoraces or hemothoraces, thoracotomy for unstable patients or uncontrolled bleeding, and video-assisted thoracoscopy for stable patients or issues like persistent hemorrhage or air leakage.

Uploaded by

hashem
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Surgical intervention

• Thoracic gunshot injury may have


variable presentation and the
treatment plan differs. The risk of
injury to heart, major blood vessels
and the lungs should be evaluated in
every patient with rapid clinical
examination and basic monitoring
and surgery should be considered as
early as possible whenever
indicated.
Surgical intervention
 When should the thoracic surgeon definitely be involved?

According to the Advanced Trauma Life Support (ATLS ) guideline, this is recommended as follows:

 Blood loss >1,500 mL initially or >200 mL/hour over 2–4 hours;


 Haemoptysis;
 Massive subcutaneous emphysema;
 Important air-leakage over the chest tub.
 Uncertain images on the chest X-ray or CT thorax.
 Injury of the heart or large vessels (blood loss/pericardial tamponade).
 Remaining of bullet in the lung
Teqnaques and procedures
Tube Thoracotomy
-Tube thoracotomy (TT) placement
belongs among the most
commonly performed procedures.
Despite many benefits of TT
drainage, potential for significant
morbidity and mortality exists.
-Tube Thoracotomy is indicated in
the presence of clinically significant
pneumothorax or hemothorax
Teqnaques and procedures
THORACTOMY
is an incision into the pleural
space of the chest.
Types of incision
-The antero-lateral thoracotomy
-The postero-lateral
thoracotomy
-The bilateral anterior
thoracotomy (clamshell incision)
Teqnaques and procedures
Indication for thoracotomy
 Patients with a penetrating thoracotomy wound who have
acute deterioration (vital signs remain orbecome unstable
(severe shock SBP<50). If patient is in mild or moderate
shock (SBP 50-90mmHg) and shock persists or rapidly
recurs after 2-3 liters of balanced electrolyte solution is
infused in 10 mins, then ER thoractomy is indicated
 Patients with uncontrollable hemorrhage (initial chest tube
output is higher than 20ml/kg(1500-2000ml) or
subsequent output is is >200ml/hr for 4 consecutive hours
or longer.
 Cardiac tamponade
 Patients experiencing cardiac arrest
Cont…..
 Patients with suspicion of a major thoracic vascular injury at the
thoracic inlet with hemodynamic instability
 Massive air leak from the chest tube
 Patients with clinical evidence of an air embolism due to lung
parenchymal or hilar injuries.
 Impalement wounds to the chest
 Bullet embolism to heart or pulmonary artery
 Radiographic evidence of great vessel injury
Teqnaques and procedures
 video-assisted thoracoscopy (VATS)
is a minimally invasive surgical technique used to diagnose
and treat problems in your chest.
Indications for VATS in severely injured patients:
(Penetrating) injury with little blood loss in a stable patient;
Persistent hemothorax; Early VATS has indeed replaced open
thoracotomymore and more for the treatment of undrained
hemothorax.
Empyema;
Persistent air-leakage;
Suspicion of diaphragmatic rupture.

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