domingo, 30 de noviembre de 2014

Trauma de tórax/Chest trauma

Predictores de la evolución después de trauma cerrado de la pared torácica. Desarrollo y validación externa de modelo de pronóstico 

Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model.
Battle C, Hutchings H, Lovett S, Bouamra O, Jones S, Sen A, Gagg J, Robinson D, Hartford-Beynon J, Williams J, Evans A.
Crit Care. 2014 May 14;18(3):R98. doi: 10.1186/cc13873.
INTRODUCTION: Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. .... RESULTS: Significant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98). CONCLUSIONS: In our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient.

Trauma cerrado del tórax

Blunt chest trauma.
Fish A, Shaikh F, Sanchez R, O'Donnell S, Rosenthal A, Kerr L, Lee S, Kiffin C, Lubin D, Carrillo E.
J Surg Case Rep. 2014 Jun 2;2014(6). pii: rju053. doi: 10.1093/jscr/rju053.
Blunt aortic injury is the most lethal injury of the thorax, of which aortic transection is the second leading cause of death. Pseudoaneurysm formation is seen in patients who survive the injury and arrive to the emergency department with small or partial-thickness tears of the aorta. In general, the proximal descending aorta is most commonly afflicted due to the relatively mobile aortic arch moving against the fixed descending aorta. There are several factors associated with a high risk of aortic injury including high-speed motor vehicle collision (MVC) accidents, unrestrained drivers and passengers, extensive impact/collision and abrupt deceleration of motor vehicles. In this case study, a 28-year-old male patient with a thoracic aorta injury is presented. Diagnostic findings consistent with transection and/or dissection and a review of his surgical management are also discussed.

La asociación entre trauma cardiaco contuso y fractura esternal aislada

The Association between Blunt Cardiac Injury and Isolated Sternal Fracture.
Dua A1, McMaster J2, Desai PJ3, Desai SS4, Kuy S5, Mata M6, Cooper J6.
Cardiol Res Pract. 2014;2014:629687. doi: 10.1155/2014/629687. Epub 2014 Feb 6.
The treatment of isolated sternal fractures (ISF) throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years) with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77) were admitted to hospital with 66% (58) of them discharged within 48 hours. Two (2%) patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63%) patients with only 2 (2%) having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7%) patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER.

Anestesiología y Medicina del Dolor
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