Academic literature on the topic 'Penetrating Thoracic Trauma'

Introduction Penetrating thoracic trauma is common and costly. Injuries are frequently and selectively amenable to non-operative management. Our selective approach to penetrating thoracic trauma is reviewed and the effectiveness of our clinical algorithms confirmed. Additionally, a basic cost analysis was undertaken to evaluate the financial impact of a selective nonoperative management approach to penetrating thoracic trauma. Materials and methods The Pietermaritzburg Metropolitan Trauma Services electronic regional trauma registry hybrid electronic medical records were reviewed, highlighted all penetrating thoracic traumas. A micro-cost analysis estimated expenses for active observation, tube thoracostomy for isolated pneumothorax greater than 2 cm and tube thoracostomy for haemothorax. Routine thoracic computed tomography does not form part of these algorithms. Results Isolated thoracic stab wounds occurred in 589 patients. Eighty per cent (472 cases) were successfully managed nonoperatively. Micro-costing shows that active observation costs 4,370 ZAR (£270), tube thoracostomy for isolated pneumothorax costs 6,630 ZAR (£400) and tube thoracostomy for haemothorax costs 21,850 ZAR (£1,310). Discussion Penetrating thoracic trauma places a striking financial burden on our limited resources. Diligent and serial clinical assessments, alongside basic radiology and stringent management criteria, can accurately stratify patients to correct clinical algorithms. Conclusion Selective nonoperative management for penetrating thoracic trauma is safe and effective. Routine thoracic computed tomography is unnecessary in all patients with isolated thoracic stab wounds, which can be reserved for a select group who are identifiable clinically. Routine thoracic computed tomography would not be financially prudent across Pietermaritzburg Metropolitan Trauma Services. Government action is required to reduce the overall incidence of such trauma to save resources and patients.

Introduction: The abdominal trauma is an important cause of morbility and mortality, abdomen is the 3th zone of human anatomy more affected by traumatism that require surgery and hospitalization. Evaluation of penetrating abdominal trauma aims to identify patients that requires surgical treatment. Objective: The objective of this study was to compare white blood cells levels in patients with penetrating abdominal trauma isolated and associated with osseous and/or thoracic injury. Patients and methods: A transversal study comparing two groups of abdominal penetrating trauma patients; penetrating abdominal trauma isolated versus penetrating abdominal trauma associated with osseous and or thoracic injury. We examined the level of white blood cells as a factor associated with major injury. Results: Our study showed a difference in mean of white blood cells count between the two groups that was statistically significant (p=0.01). A positive relationship between penetrating abdominal trauma associated with osseous and or thoracic injury was found. Conclusion: A significant elevation in white blood cells count in penetrating abdominal trauma associated with osseous and or thoracic injury is observed in comparison with penetrating abdominal trauma isolated.

<strong>ABSTRACT</strong> The purpose of this investigation was to evaluate factors affecting the outcome following penetrating cardiac trauma in a developing country and to compare our results with others in developed countries. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, SBP, GCS, ISS, RTS, TRISS and mortality were performed. This study included 35 patients; all were males. Mortality rate was 22.8%. It was significant with low SBP (p =0.021), GCS ˂ 9 (p =0.02), non-presentation with tamponade (p = 0.023), low ISS (p =0.02), low RTS (p =0.007), low TRISS (p = 0.003), less blood transfusion (p =0.001) and longer time before entrance to OR (p= 0.019). Meanwhile, mortality were not significant with age (p =0.33), mechanism of injury (p =0.16), other associated injuries (p =0.16) or associated intra-abdominal injuries (p= 0.16). Rapid assessment and prompt surgical intervention may reduce mortality. Even in a developing country, mortality rates could reach those in developed countries depending on clinical skills and accessible technology tools. <strong>Key words</strong>: Thoracic injuries, penetrating cardiac injuries, thoracic trauma <strong>REFERENCES</strong> Alexander, B., Dan, H. (2012). Negative FAST and echocardiography in penetrating cardiac injuries decompressing to the chest and peritoneal cavities. Injury Extra, 43: 139-141. Bruno, M.T.P., Vitor , B.N.,&nbsp; Thiago,&nbsp; R.A.C.,&nbsp; Marcelo,&nbsp; P.V.&cedil; Orlando,&nbsp; P., Gustavo,&nbsp; P.F. (2013).&nbsp; Penetrating cardiac trauma: 20-y experience from a university teaching hospital. Journal of Surgical Research, 30: e1-e6. Ceviker, K., Tulay, C., Sahinalp, S., Atlı, H.F. (2014). Factors affecting mortality in cardiac injury of penetrating thorax trauma: a retrospective study. Gaziantep Med J, 20: 35-41. Clarke, D.L., Muhammed, A., Reddy, K., Thomson, S.R. (2011). Emergency operation for penetrating thoracic trauma in a metropolitan surgical service in South Africa. J Thorac Cardiovasc Surg, 142: 563-568. Cury, F., Baitello, A.L., Echeverria, R.F., Espada, P.C., Pereira, de Godoy J.M. (2009). Rates of thoracic trauma and mortality due to accidents in Brazil. Ann Thorac Med, 4: 25-26. Niall, M., Kieran. M. (2011). Penetrating thoracic trauma. Surgery, 29: 227-230. O&rsquo;Connor, J., Ditillo, M., Scalea, T.&nbsp; (2009). Penetrating cardiac injury. J R Army Med Corps, 155: 185-189. Onan, B., Demirhan R., &Ouml;z, K., Onan, İ.S. (2011). Cardiac and great vessel injuries after chest trauma: our 10-year experience. Turkish Journal of Trauma &amp; Emergency Surgery, 17:423-429. Serdar, O., Refik U., Alper, A., Gungor, A., Cemal, O. (2011). Urgent thoracotomy for penetrating chest trauma: Analysis of 158 patients of a single center. Injury, Int J Care Injured, 42: 900-904. Tariq, U.M., Faruque, A. Ansari, H., Ahmad, M., Rashid, U., Perveen, S. (2011). Changes in the patterns, presentation and management of penetrating chest trauma patients at a level II trauma center in Southern Pakistan over the last two decades. Interact Cardio vascThoracSurg, 12: 24-27. &nbsp;

Aim:Penetrating traumas in children, caused by firearms or sharp instruments, are relatively rare, accounting for 10-20% of pediatric traumas. These traumas are serious and can lead to significant consequences, hence the need for prompt and multidisciplinary management. Materials and Methods:The study is a retrospective analysis of pediatric patients treated for PT in the intensive care unit. Patients were divided into two groups based on the cause of injury: sharp instrument wounds and firearm wounds. Data collected included age, gender, diagnosis at ICU admission, type of trauma, cause of trauma (assault, suicide), vital signs, nature of trauma (thoracic, abdominal, cranial, extremity), associated organ failures, surgical needs, performed surgeries or procedures, need for respiratory and cardiovascular support, transfusion requirements, lab parameters (blood gases and organ functions), ICU stay duration, and outcomes. Results:Between April 2022 and November 2023, a total of 425 pediatric cases were treated for trauma in the ICU, with a 6% frequency of PT. The majority of PT cases were in the adolescent age group and were male (76%). The cause of PT was violence in 88% (22/25) cases and attempted suicide in 12% (3/25) cases. 72% were caused by sharp objects and 28% were caused by gunshot wounds. The location of trauma was thoracic in 48% (12/25), abdominal in 44% (11/25), thoraco-abdominal in 4% (1/25), and lower extremity in 4% (1/25). There was no cranial penetrating trauma. In most cases (80%), thoracic and/or abdominal surgery, including tube thoracostomy, was required to treat hemopneumothorax. Blood transfusion was performed in 52% of the cases (13/25). Two cases required non-invasive mechanical ventilation, and one case required mechanical ventilation. The cases were hospitalized in the PICU for a mean period of 3,7 days. All cases were discharged. There were no deaths. Conclusion: Penetrating traumas are rare in children but can lead to serious consequences. Therefore, a rapid and multidisciplinary approach is vital in the management of PT cases in children.

Objective — to study in detail the mechanisms and to investigate the imaging manifestations of combat-related penetrating thoracic injuries.&#x0D; Materials and methods. To perform the work, a literature search was provided according to the criterion «Thoracic penetrating combat-related trauma». 32 literary sources were selected for this request. Frag­ments of the clinical experience described in the literature according to the selected sources were illustrated by our own clinical cases of patients who were treated in Kharkiv medical institutions in 2022 for penetrating combat-related thoracic injuries.&#x0D; Results and discussion. Among victims who received chest injuries, polytrauma was most often diagnosed, complicated by several mechanisms of injury associated with penetrating, blunt, and explosive injuries. Pneumothorax and pulmonary contusion were the most common chest injuries. Thoracic injuries, thoracic vascular injuries, and lung ruptures were associated with the highest mortality rates, whereas pulmonary contusions, pneumothorax, and chest wall injuries were associated with relatively lower mortality rates. Chest X-ray is the first-line imaging method during the initial assessment of thoracic trauma in combat and non-combat situations. Such an examination is particularly important in polytrauma situations where multiple fatal injuries can be rapidly diagnosed in order to rapidly triage and include such an injury in the initial evaluation. Tension pneumothorax, large hemothorax, chest fragmentation, and some other lesions can be quickly diagnosed with a portable chest X-ray. Computed tomography (CT) of the chest is an important component of the comprehensive trauma evaluation, which allows to diagnose life-threatening injuries in hemodynamically stable patients with suspected multiple injuries not identified on chest X-ray. Chest CT detects 20 % more pathologies compared to chest X-ray.&#x0D; Conclusions. Combat-related thoracic trauma continues to be a significant contributor to the mortality rates of those injured in military operations. A clear injury pattern and atypical imaging manifestations of thoracic trauma are important to recognize at an early stage because of the acuteness of this category of patients and the impact of an accurate diagnosis on clinical management. Chest X-ray remains the main diagnostic tool. However, in modern and well-equipped institutions, chest CT, video-assisted thoracoscopy, and ultrasound scanning of the abdominal and chest cavity play an important role in the diagnosis of thoracic trauma. Quick and high-quality diagnosis and treatment are possible only in direct cooperation between surgeons and radiologists.

Combat-related thoracic trauma is a significant cause of morbidity and mortality in all military opera­tions. Penetrating, blunt, and explosive wounds are the most common mechanisms of injury. Visualization diagnosis plays a key role in the treatment. This review discusses the visualization signs of chest injuries from blunt trauma and blast trauma. Objective was to study in detail the mechanisms and visualization signs of non-penetrating combat-related thoracic trauma. 235 literature sources were found in the PubMed system by the query Thoracic AND Trauma AND Combat, 34 of which were selected for further detailed study. In modern warfare, thoracic trauma accounts for 8.6—16.0 % of casualties. Chest X-ray and CT are the visualization methods most commonly used in the evaluation of polytrauma patients from combat and peacetime. Chest X-ray can be quickly obtained in a patient with blunt trauma and emergency conditions that include tension pneumothorax, large hemothorax, chest compression, and others. Chest CT is an important component of trauma visualization. Compared to chest X-ray, chest CT identifies 20 % more pathology, and occult chest trauma due to blunt force trauma can be identified in 71 % of patients. CT provides 38—81 % additional diagnoses compared to chest X-ray.Thoracic trauma is often diagnosed in places of combat. As medical imaging technology moves closer to combat areas, this tool is becoming increasingly available to aid in the diagnosis and rapid treatment of combat-related thoracic trauma. Clinical and surgical management of the traumatized patient relies on skills learned in modern civilian training and honed in war. However, imaging of blunt and explosive injuries may be different in civilian and military settings. The distinct injury pattern and atypical imaging findings of blunt trauma and blast lung injury are important to recognize at an early stage because of the severity of this pathology and the impact of an accurate diagnosis on clinical management.We present our own observations of patients who were treated at the Military Medical Clinical Center of the Northern Region (Kharkiv) in 2022 for non­penetrating combat­related thoracic trauma.

Un traumatisme contondant pourrait entrainer une occlusion aortique aigue induisant une onde de pression intraluminale réfléchie avec un effet maximal au niveau de la crosse aortique. Le but de l'étude était de reproduire la circulation physiologique intra-aortique à l’aide d’un banc d’essai expérimental, d’évaluer si une occlusion aortique aigue entrainait une onde de pression rétrograde et d’évaluer l’impact du canal artériel. Un modèle animal a été instrumenté par une canulation de l’aorte ascendante avec une pompe et une électrovanne pour le flux pulsatile et un débitmètre à ultrasons pour contrôler le débit d'entrée. Des capteurs de pression ont été placés dans la crosse aortique et le long de l'aorte thoracique. Un dispositif d'occlusion aortique par clampage a été placé sur l'aorte descendante. Une acquisition des signaux analogiques des capteurs de pression a été fait sans clampage pendant des 10 cycles pour l’écoulement pulsé puis après le clampage pendant 3 cycles (la 1re étant celle où a eu lieu le clampage). Ces essais ont été répétés après section du ligament artériel. Les ondes de pression ont été analysées par une décomposition en séries de Fourier. L’onde avant l'occlusion fournissait le schéma général de propagation de l'onde de pression physiologique et a permis de caractériser les amplitudes, les phases des harmoniques. L’onde transitoire due à la fermeture soudaine de l’aorte, i.e. coup de bélier, et l’onde de pression modifiée par l’occlusion complète puis partielle de l’aorte ont été séparées. L’onde transitoire a été analysée à l’aide de la transformée de Fourier. Six systèmes cardio-respiratoires porcins, regroupés en deux types distincts en fonction du rapport épaisseur/diamètre et du rayon de courbure de l’arc aortique, ont été perfusés. Avant clampage, une augmentation des amplitudes des harmoniques a été observée lors de la propagation de l'onde de pression le long de l’aorte. De plus, le déphasage augmentait, indiquant un délai croissant. Deux types de comportements aortiques ont été identifiés, liés aux variations géométriques, influençant la compliance et la propagation des ondes. Ces différences entraînent des conditions de propagation et de réflexion distinctes entre les deux groupes d'aortes, modifiant les caractéristiques de l'onde de pression. Après clampage, l'analyse de Fourier montre des profils d'amplitudes similaires mais amplifiée pour les premiers harmoniques, mais avec des amplitudes significatives au-delà du 5e harmonique, surtout au premier cycle d'occlusion. Ce phénomène est plus prononcé dans le groupe d'aortes ayant une compliance plus faible et une courbure de l'arc plus importante. L'occlusion de l'aorte a entrainé une forte distorsion de l'onde de pression avec une amplification de tous les harmoniques. La transformée de Fourier de l’onde de pression aortique est décalée vers les hautes fréquences indiquant des changements significatifs dans les caractéristiques hémodynamiques du flux sanguin avec une augmentation soudaine de la rigidité de la paroi aortique. Dans les cas sans et avec clampage de l’aorte, l’effet de la présence du ligament artériel est similaire. L’absence de ligament artériel modifie localement les propriétés de la paroi aortique et donne une mobilité accrue à l’arc aortique. Les différences géométriques des aortes influencent la propagation de l'onde de pression. Une courbure plus prononcée de l'arc aortique et un rapport épaisseur/diamètre plus élevé tendent à amplifier les harmoniques de l'onde de pression, tandis qu'une géométrie plus régulière favorise l'amortissement des amplitudes des harmoniques. Cette étude a montré que la reproduction de la circulation cardiovasculaire était réalisable et permettait de mesurer l'onde de pression à travers l'aorte thoracique. Une onde de pression rétrograde a été mise en évidence après une occlusion aortique distale aigue sans entrainer de rupture traumatique de l’aorte sur ce modèle expérimental<br>Blunt trauma could lead to acute aortic occlusion inducing a reflected intraluminal pressure wave with a maximal effect at the aortic arch. The aim of the study was to reproduce the physiological intra-aortic circulation using an experimental test bench, to evaluate whether acute aortic occlusion leads to a retrograde pressure wave and to assess the impact of the ductus arteriosus. An animal model was instrumented by cannulation of the ascending aorta with a pump and solenoid valve for pulsatile flow and an ultrasonic flowmeter to monitor the inflow. Pressure transducers were placed in the aortic arch and along the thoracic aorta. An aortic clamp occlusion device was placed on the descending aorta. An acquisition of the analog signals of the pressure sensors was done without clamping for 10 cycles for the pulsed flow then after the clamping for 3 cycles (the 1st being the one where the clamping took place). These tests were repeated after section of the arterial ligament. The pressure waves were analyzed by a Fourier series decomposition. The wave before the occlusion provided the general propagation pattern of the physiological pressure wave and allowed to characterize the amplitudes, the phases of the harmonics. The transient wave due to the sudden closure of the aorta, i.e. water hammer, and the pressure wave modified by the complete then partial occlusion of the aorta were separated. The transient wave was analyzed using the Fourier transform. Six porcine cardiorespiratory systems, grouped into two distinct types based on the thickness-to-diameter ratio and the radius of curvature of the aortic arch, were perfused. Before clamping, an increase in harmonic amplitudes was observed during pressure wave propagation along the aorta. In addition, the phase shift increased, indicating an increasing delay. Two types of aortic behaviors were identified, related to geometric variations, influencing compliance and wave propagation. These differences result in distinct propagation and reflection conditions between the two groups of aortas, modifying the pressure wave characteristics. After clamping, Fourier analysis shows similar but amplified amplitude profiles for the first harmonics, but with significant amplitudes beyond the 5th harmonic, especially in the first occlusion cycle. This phenomenon is more pronounced in the group of aortas with lower compliance and greater arch curvature. Aortic occlusion resulted in a strong distortion of the pressure wave with amplification of all harmonics. The Fourier transform of the aortic pressure wave is shifted to high frequencies indicating significant changes in the hemodynamic characteristics of blood flow with a sudden increase in aortic wall stiffness. In cases without and with aortic clamping, the effect of the presence of the arterial ligament is similar. The absence of the arterial ligament locally modifies the properties of the aortic wall and gives increased mobility to the aortic arch. Geometric differences of the aortas influence the propagation of the pressure wave. A steeper curvature of the aortic arch and a higher thickness-to-diameter ratio tend to amplify the pressure wave harmonics, while a more regular geometry favors the damping of the harmonic amplitudes. This study showed that the reproduction of cardiovascular circulation was feasible and allowed the measurement of the pressure wave across the thoracic aorta. A retrograde pressure wave was demonstrated after an acute distal aortic occlusion without causing traumatic aortic rupture in this experimental model

Skeletal trauma occurs in many blunt, ballistic and blast impact events. Even though the personal body armors and protective equipment were effective in stopping the penetration of bullets or fragments, the resulting impact loading could lead to the significant injuries and fractures to the thoracic skeleton and extremities. The finite element (FEM) method, with its capability to handle complex geometries and nonlinear materials, are commonly used to analyze the tissue biomechanical responses and correlate the simulation results with the injury outcomes. However, it is very difficult to construct the three-dimensional (3D) FEM model for the skeletal biomechanics analysis because of the complex geometry and different materials involved. Moreover the simulation of 3D FEM model is computationally expensive because both small element size and high speed of sound in materials lead to very small time step in an explicit transient analysis. The simulation process is often not robust enough when the model experiences the large deformation. To shorten modeling and simulation times, we have developed a fast running model based on a novel nonlinear beam element for the skeletal impact biomechanics analysis. In contrast to the conventional beam elements, the kinematics of the developed beam element is free of rotational degrees of freedom (DOFs). The current beam element offers the desired constant lumped mass matrix for the large deformable explicit transient analysis. The realistic treatment of junctions and surface intersections among beams becomes straightforward. Furthermore the model can account for the irregular shape and different materials at beam cross sections by using the numerical integration. The sophisticated material models such as elastoplasticity can also be incorporated directly in the integration points. Thus the fast running model is suitable for the analysis of complex nonlinear composite structures such as the loading-carrying thoracic skeleton and extremities. The stereolithograph (STL)-based anatomical geometry of skeletal structure is used to extract the one-dimensional (1D) curved beam model and the associated beam cross sections. The anatomical surface of skeleton is also utilized for the calculation of transferred loads to the underlined beams. The 3D responses such as displacements and stresses from the fast running model are subsequently reconstructed on the anatomical surface for the visualization and skeletal trauma analysis. We demonstrate the efficiency of such modeling technique by simulating the rib cage and the lower extremity under the impact loadings. As compared to the 3D FEM model, the developed model runs fast and robust, and achieves good results without the need of laborious 3D meshing process.