Hemotórax Masivo. – Tórax Inestable. – Taponamiento Cardiaco. Feliciano DV, Mattox KL et al. Trauma. 6th edition. McGraw Hill; Trauma. Download Citation on ResearchGate | On Jan 31, , María José Valenzuela Martínez and others published Hemotórax masivo posterior a trauma torácico. Se describe el caso de un paciente de 55 anos afecto de un tromboembolismo pulmonar que desarrollo un hemotorax masivo mientras estaba sometido a.
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There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Almost all cases diagnosed in the acute phase are associated with one or several organ lesions that are life-threatening.
Rapid assessment of the patient’s clinical situation is necessary, along with meticulous observation of chest radiographs. This is especially true in the case of penetrating wounds in blunt chest trauma, as in the case we present. A year-old male was treated in the Emergency Department due to thoracic pain and dyspnoea after thoracoabdominal trauma that occurred when getting out of the bathtub. The patient reported no cranial trauma or injuries to other areas.
Prior to the accident, the patient had been healthy and had no medical history of interest. Physical examination showed a permeable airway and sharp pain in the ribs during inspiration, with crepitation of the left ribcage and no observed flail chest.
Cardiorespiratory auscultation was normal with audible vesicular murmur.
On chest radiography, unipolar fractures were observed in the left ribs 5th—9th with no consolidations, collections or signs of pneumothorax. Thoracoabdominal CT scan with intravenous contrast confirmed these rib fractures and that the 5th, 6th and 7th were displaced.
Mild oedema and emphysema of the wall were observed with minimal left pleural effusion. There were no images of pneumothorax, signs of laceration or important foci of pulmonary contusion.
There were also no abdominal findings of interest. The patient was hospitalised for further monitoring and analgesia. After 72 h, the patient started to sit up. The patient had episodes of severe hypotension and bradycardia of up to 45 lpm, which initially responded to fluids and Trendelenburg position.
Meaning of “hemotórax” in the Spanish dictionary
Auscultation showed abolition of the vesicular murmur in the mqsivo two-thirds of the left hemithorax. Jemotorax radiograph showed evidence of moderate-severe pleural effusion Fig. A chest drain tube was placed in the 5th intercostal space on the anterior axillary midline according to the standard technique, and cc of blood were immediately collected.
Simultaneously, the patient had another hypotensive episode, which he overcame with fluid therapy. Another chest radiograph verified the correct placement of the chest drain but no lung re-expansion.
Given these findings and the haemodynamic instability of the patient, urgent exploratory thoracotomy was indicated when the drained content had already reached cc. Chest radiograph after 48 h: Lateral thoracotomy was performed in the 5th intercostal space, and a massive haemothorax was evacuated cc with abundant lavage. We confirmed displaced fractures of the 5th to 7th ribs. The 7th had splintered edges, with one of the edges aimed towards the diaphragm and laceration of its corresponding dome measuring 4 cm, which was bleeding profusely Fig.
We inspected the lung and found no injury. The rib edges were trimmed and smoothed. Chest wall closure was performed with the insertion of 2 chest drains.
Diaphragm laceration with active haemorrhage after evacuating the haemothorax. Exposure and suture of diaphragm tear; bleeding was already controlled. The patient remained stable during surgery and required cc crystalloids and the transfusion of 3 units of blood.
The patient stayed in the ICU for 24 h, where he was haemodynamically stable. On the hospital ward, his condition continued to improve and the patient was discharged on the 4th day after surgery with normalised parameters. At the follow-up visit 1 month later, no complications were observed.
Massive haemothorax involves the sudden accumulation of more than cc of blood or one-third the patient’s blood volume in the thoracic cavity.
Massive haemothorax also involves comprised respiratory function due to the deficient lung expansion that impedes adequate ventilation and hypoxaemia. This situation, together with the accompanying hypovolemic shock, is life-threatening.
During the examination of multiple trauma patients, haemodynamic instability associated with hypovolemic shock, accompanied by absence of vesicular murmur and dullness to percussion in the hemithorax, are diagnostic of massive haemothorax all of which were present in this case.
Haemothorax | Radiology Reference Article |
Measurement of Hb enables us to easily determine the estimated blood loss and it is a fundamental parameter that contributes to better blood volume replacement with transfusion of blood products, if necessary. The use of CT scans in massive haemothorax is excluded because of the patient instability with this condition. Initial management involves maivo substitution of blood loss and decompression of the thoracic cavity using a chest drain.
The selection of the surgical approach is essential in this situation and is defined by the initial suspicion of the injury and the understanding of the exposure offered by the incision. The approach we chose was lateral thoracotomy in the 5th intercostal space, which provided good visualisation of the diaphragm surface and rib fractures in order to control any bleeding and for stabilisation.
It also enabled us to explore the entire chest cavity, parenchyma and hilum in order to rule out any concomitant injuries. Cases of massive, late-onset and sudden haemothorax described in the literature are always associated with displaced lower rib fractures. We conclude that, in patients with multiple trauma injuries and displaced lower rib fractures, 7 undetected diaphragm injuries can result in massive haemothorax, especially when the patient starts to move and the pain is disguised by the fractured rib pain.
It is essential to always monitor early masifo of masifo shock and maintain a high index of suspicion. The chest should be studied in detail, as the pain from the rib trauma can camouflage injury to the diaphragm. Please cite this article as: Una herida penetrante en el traumatismo cerrado. Previous yemotorax Next article.
August – September Pages ee80 Pages A Penetrating Injury in Blunt Trauma.
HEMOTÓRAX – Definition and synonyms of hemotórax in the Spanish dictionary
This item has received. Show more Show less. This is especially true in the case of penetrating wounds in blunt chest trauma, as in the case we present.
Case Report A year-old male was treated in the Emergency Department due to thoracic pain and dyspnoea after thoracoabdominal trauma that occurred when getting out of the bathtub. Hejotorax auscultation was normal with audible vesicular murmur. There were also no abdominal findings of interest. Given these findings and the haemodynamic instability of the patient, urgent exploratory thoracotomy was indicated when the drained content had already reached cc.
Diaphragm laceration with active haemorrhage after evacuating the haemothorax. Exposure and suture of diaphragm tear; bleeding was already controlled. Surg Clin North Am, 87pp. Diaphragmatic injury hemotorad as delayed hemothorax. Mil Med,pp.
Delayed massive hemothorax due to diaphragmatic injury by lower rib fracture. Kyobu Geka, hemotorapp. Emergencias, 12pp. Subscribe to our Newsletter. Print Send to a friend Export reference Mendeley Statistics. Arteriovenous Malformations in Serratus Anterior Influence of Simultaneous Liver and Peritoneal Resection on Si continua navegando, consideramos que acepta su uso. To improve our services and products, we use “cookies” own or third parties authorized to show advertising related to client preferences through the analyses of navigation customer behavior.
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