Impalement injuries are rare. We present here a case of impalement injury of chest and its management. A 10-year-old boy fell from a tree and landed on pointed bamboo object. He was diagnosed as a case of impalement injury with right-sided pneumothorax. A right anterolateral thoracotomy with removal of foreign body and repair of lung laceration was done. The patient in the postoperative period remained stable. He was discharged on day 10. Thoracic impalement injuries are dangerous injuries because of close proximity of the impaled objects to the heart and major vessel. The impaled object should be left as such and an urgent transfer to a facility dealing with such type of injury is required. A thoracotomy incision based on the tract should be employed. Postoperative patient should be put on broad-spectrum antibiotic along with chest physiotherapy.
{"title":"Impalement injury to chest due to bamboo stick","authors":"Majid Anwer, M. Uddin, F. Ahmed, Md Ur Rahman","doi":"10.4103/jctt.jctt_15_21","DOIUrl":"https://doi.org/10.4103/jctt.jctt_15_21","url":null,"abstract":"Impalement injuries are rare. We present here a case of impalement injury of chest and its management. A 10-year-old boy fell from a tree and landed on pointed bamboo object. He was diagnosed as a case of impalement injury with right-sided pneumothorax. A right anterolateral thoracotomy with removal of foreign body and repair of lung laceration was done. The patient in the postoperative period remained stable. He was discharged on day 10. Thoracic impalement injuries are dangerous injuries because of close proximity of the impaled objects to the heart and major vessel. The impaled object should be left as such and an urgent transfer to a facility dealing with such type of injury is required. A thoracotomy incision based on the tract should be employed. Postoperative patient should be put on broad-spectrum antibiotic along with chest physiotherapy.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"6 1","pages":"32 - 34"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41802236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Operative stabilization of both flail and nonflail rib fractures has become very common, with a 76% increase in community hospitals over the past 10 years. This review will explain the rationale and evidence for improved outcomes with operative management of rib fractures, describe the contemporary strategy, and give an algorithm to follow for the management of critical patients in the intensive care unit (ICU) setting with rib fractures. A PubMed and Medline literature search was conducted with the search terms of rib fractures, rib stabilization, rib plating, chest trauma, chest wall, flail chest, nonflail, and ribs. The level of evidence supporting an intervention was evaluated based on the available prospective, randomized trials, nonrandomized trials, retrospective studies, meta-analyses, cohort studies, and reviews. Selected publications of interest on both rib plating and conservative treatment were retrieved and their bibliographies were also reviewed to identify relevant publications. Data from the relevant publications were reviewed, summarized, and the information synthesized. Rib plating has shown improved outcomes in both flail and nonflail rib fractures. Both prospective and retrospective data document a decreased duration of mechanical ventilation, decreased mortality, less pain, decreased incidence of pneumonia, decreased need for tracheostomy, decreased length of ICU and hospital stay, faster return to work, less overall cost, and better pulmonary function at 6 months. The proposed algorithm based on the presented data allows the physician to easily determine which patients are appropriate for rib plating.
{"title":"A contemporary algorithm to manage acute rib fractures in the intensive care unit","authors":"J. Carr","doi":"10.4103/jctt.jctt_13_21","DOIUrl":"https://doi.org/10.4103/jctt.jctt_13_21","url":null,"abstract":"Operative stabilization of both flail and nonflail rib fractures has become very common, with a 76% increase in community hospitals over the past 10 years. This review will explain the rationale and evidence for improved outcomes with operative management of rib fractures, describe the contemporary strategy, and give an algorithm to follow for the management of critical patients in the intensive care unit (ICU) setting with rib fractures. A PubMed and Medline literature search was conducted with the search terms of rib fractures, rib stabilization, rib plating, chest trauma, chest wall, flail chest, nonflail, and ribs. The level of evidence supporting an intervention was evaluated based on the available prospective, randomized trials, nonrandomized trials, retrospective studies, meta-analyses, cohort studies, and reviews. Selected publications of interest on both rib plating and conservative treatment were retrieved and their bibliographies were also reviewed to identify relevant publications. Data from the relevant publications were reviewed, summarized, and the information synthesized. Rib plating has shown improved outcomes in both flail and nonflail rib fractures. Both prospective and retrospective data document a decreased duration of mechanical ventilation, decreased mortality, less pain, decreased incidence of pneumonia, decreased need for tracheostomy, decreased length of ICU and hospital stay, faster return to work, less overall cost, and better pulmonary function at 6 months. The proposed algorithm based on the presented data allows the physician to easily determine which patients are appropriate for rib plating.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"6 1","pages":"4 - 14"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49403876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.1097/00005373-200108001-00009
Kerrin S. Sunshine, M. Peñuela, D. Defta, Eric Z. Herring, M. Sajatovic, J. Traeger, B. Shammassian
arrest), high-velocity CT negative TBI, and non-injured controls. Differences in GFAP and UCH-L1 concentrations were assessed using the ttest and Wilcoxon rank-sum test. Support vector machine learning was then utilized for the classification of the patient samples in our prediction tasks. Prediction accuracy was measured by the area under the curve (AUC), precision, recall, and F1 score. RESULTS: 111 matched GFAP and UCH-L1 samples were analyzed; 36 traumatic hemorrhage, 10 spontaneous hemorrhage, 16 oxygen deprivation, 10 high-velocity CT negative TBI, and 39 healthy controls. GFAP concentrations were statistically different (P < .05) in all but one comparison, high-velocity CT negative TBI and oxygen deprivation injury, while UCH-L1 concentrations were only statistically different for comparisons with non-injured control subjects. When GFAP and UCH-L1 concentrations were combined for prediction classification, the AUC for comparisons were as follows; 0.90 spontaneous vs traumatic hemorrhage, 0.93 oxygen deprivation vs spontaneous hemorrhage, 0.84 oxygen deprivation vs traumatic hemorrhage, 0.94 CT negative TBI vs traumatic hemorrhage, 1.00 CT negative TBI vs spontaneous hemorrhage, and 0.96 CT negative TBI vs oxygen deprivation. The classification prediction using both biomarkers for healthy controls and highvelocity CT negative TBI demonstrated an AUC of 0.93, precision 0.9, recall 0.84, and F1 score of 0.87. CONCLUSION: Serum concentrations of S100B and GFAP collected within 32 hours of injury have utility in classifying braininjured subjects based on the etiology of their injuries which has implications for early targeted management and prognostication of brain injury.
{"title":"Antibiotic prophylaxis for penetrating brain injury.","authors":"Kerrin S. Sunshine, M. Peñuela, D. Defta, Eric Z. Herring, M. Sajatovic, J. Traeger, B. Shammassian","doi":"10.1097/00005373-200108001-00009","DOIUrl":"https://doi.org/10.1097/00005373-200108001-00009","url":null,"abstract":"arrest), high-velocity CT negative TBI, and non-injured controls. Differences in GFAP and UCH-L1 concentrations were assessed using the ttest and Wilcoxon rank-sum test. Support vector machine learning was then utilized for the classification of the patient samples in our prediction tasks. Prediction accuracy was measured by the area under the curve (AUC), precision, recall, and F1 score. RESULTS: 111 matched GFAP and UCH-L1 samples were analyzed; 36 traumatic hemorrhage, 10 spontaneous hemorrhage, 16 oxygen deprivation, 10 high-velocity CT negative TBI, and 39 healthy controls. GFAP concentrations were statistically different (P < .05) in all but one comparison, high-velocity CT negative TBI and oxygen deprivation injury, while UCH-L1 concentrations were only statistically different for comparisons with non-injured control subjects. When GFAP and UCH-L1 concentrations were combined for prediction classification, the AUC for comparisons were as follows; 0.90 spontaneous vs traumatic hemorrhage, 0.93 oxygen deprivation vs spontaneous hemorrhage, 0.84 oxygen deprivation vs traumatic hemorrhage, 0.94 CT negative TBI vs traumatic hemorrhage, 1.00 CT negative TBI vs spontaneous hemorrhage, and 0.96 CT negative TBI vs oxygen deprivation. The classification prediction using both biomarkers for healthy controls and highvelocity CT negative TBI demonstrated an AUC of 0.93, precision 0.9, recall 0.84, and F1 score of 0.87. CONCLUSION: Serum concentrations of S100B and GFAP collected within 32 hours of injury have utility in classifying braininjured subjects based on the etiology of their injuries which has implications for early targeted management and prognostication of brain injury.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"63 1","pages":"S34-40"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88305622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rashid, K. Mattox, Paul L Tahalele, Merlinda Dwintasari, Yasser ElSaid, A. Alzaanin, L. Peixoto, José Ruiz Pier, B. Patel
{"title":"COVID-19 impact on the global surgical practice of cardiothoracic trauma","authors":"M. Rashid, K. Mattox, Paul L Tahalele, Merlinda Dwintasari, Yasser ElSaid, A. Alzaanin, L. Peixoto, José Ruiz Pier, B. Patel","doi":"10.4103/jctt.jctt_10_20","DOIUrl":"https://doi.org/10.4103/jctt.jctt_10_20","url":null,"abstract":"","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"5 1","pages":"6 - 10"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41805104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Robinson, W. Stinson, M. Zielinski, Daniel J Stephens, Brian D. Kim
Background: We hypothesized that obese patients undergoing rib stabilization would have a smaller ratio of ribs repaired to those fractured, increased days to operation, increased length of operation, were mechanically ventilated longer, required a longer stay in the intensive care unit (ICU) and hospital, and had an increased risk of developing pneumonia. Materials and Methods: This was a retrospective evaluation of patients who underwent surgical rib stabilization after trauma at a single institution over 9 years. Two hundred and seventy-three patients were divided according to body mass index (BMI) into three groups: group 1 (BMI: 15–29, n = 149), Group 2 (BMI: 30–35, n = 80), and Group 3 (BMI: 35–48, n = 44). Analysis of variance was performed to evaluate differences in outcomes in association with BMI. Two-tail t-tests were further utilized to compare Group 1 and Group 3. Results are reported in P values, with P < 0.05 being significant. Results: Sixty-eight percent were male, the mean age was 61, and 96% were Caucasian. Comorbidities: asthma (15%), chronic obstructive pulmonary disease (12%), smokers (22%), hypertension (40%), and type 2 diabetes mellitus (15%). Patients with a higher BMI had a longer average hospital length of stay (12.0, 13.4, and 15.6 days, P < 0.05). The incidence of postoperative pneumonia was increased in those with a higher BMI (10%, 12%, and 30%, P < 0.05). The remaining variables were not significant. Conclusion: Those with a higher BMI had a longer hospital stay and were at increased risk for developing pneumonia after rib stabilization. BMI did not have a significant effect on the ratio of ribs stabilized, time to operation, length of operation, days on mechanical ventilation, or ICU length of stay.
{"title":"Outcomes in obese patients undergoing rib stabilization at a single institution over 9 years","authors":"N. Robinson, W. Stinson, M. Zielinski, Daniel J Stephens, Brian D. Kim","doi":"10.4103/jctt.jctt_8_20","DOIUrl":"https://doi.org/10.4103/jctt.jctt_8_20","url":null,"abstract":"Background: We hypothesized that obese patients undergoing rib stabilization would have a smaller ratio of ribs repaired to those fractured, increased days to operation, increased length of operation, were mechanically ventilated longer, required a longer stay in the intensive care unit (ICU) and hospital, and had an increased risk of developing pneumonia. Materials and Methods: This was a retrospective evaluation of patients who underwent surgical rib stabilization after trauma at a single institution over 9 years. Two hundred and seventy-three patients were divided according to body mass index (BMI) into three groups: group 1 (BMI: 15–29, n = 149), Group 2 (BMI: 30–35, n = 80), and Group 3 (BMI: 35–48, n = 44). Analysis of variance was performed to evaluate differences in outcomes in association with BMI. Two-tail t-tests were further utilized to compare Group 1 and Group 3. Results are reported in P values, with P < 0.05 being significant. Results: Sixty-eight percent were male, the mean age was 61, and 96% were Caucasian. Comorbidities: asthma (15%), chronic obstructive pulmonary disease (12%), smokers (22%), hypertension (40%), and type 2 diabetes mellitus (15%). Patients with a higher BMI had a longer average hospital length of stay (12.0, 13.4, and 15.6 days, P < 0.05). The incidence of postoperative pneumonia was increased in those with a higher BMI (10%, 12%, and 30%, P < 0.05). The remaining variables were not significant. Conclusion: Those with a higher BMI had a longer hospital stay and were at increased risk for developing pneumonia after rib stabilization. BMI did not have a significant effect on the ratio of ribs stabilized, time to operation, length of operation, days on mechanical ventilation, or ICU length of stay.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"5 1","pages":"29 - 32"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48391828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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