Assuntos
Antivenenos/efeitos adversos , Transfusão de Sangue Autóloga/efeitos adversos , Hemotórax , Mordeduras de Serpentes/terapia , Viperidae , Adulto , Animais , Antivenenos/administração & dosagem , Djibuti , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Hemotórax/terapia , Humanos , Masculino , Reação Transfusional/diagnóstico por imagem , Reação Transfusional/terapiaRESUMO
In Japan, little is known about using the Cell Saver in treating blunt or penetrating chest trauma. We therefore report the utility of this autologous blood salvage device. Two patients underwent emergency thoracotomies with the Cell Saver to treat massive hemothorax and made full recoveries. The first was a 29-year-old man who suffered a stab injury to his chest; 5000 ml blood was collected from the thorax, of which about 3000 ml was reinfused. The second was a 51-year-old man involved in a car crash; 1600 ml blood was collected from the thorax, of which about 500 ml was reinfused. When no banked blood is available for an emergency thoracotomy, the Cell Saver is an extremely useful machine. This device is also effective in treating progressive hemorrhagic shock and helpful when the rate of blood loss exceeds the supply available from the blood bank.
Assuntos
Acidentes de Trânsito , Transfusão de Sangue Autóloga/instrumentação , Hemotórax/cirurgia , Traumatismos Torácicos/complicações , Toracotomia , Ferimentos Perfurantes/complicações , Adulto , Tratamento de Emergência , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos Perfurantes/cirurgiaRESUMO
Hemothorax and persistent thoracic bleeding is frequently an indication for thoracotomy after trauma. Unfortunately, the source of the hemorrhage is often not identified. Presently, selective arteriography and transcatheter embolization (SATE) offers a good and safe alternative to localize and control hemorrhage from arterial injuries in selected patients. The records of eight patients who underwent SATE were reviewed. There were six blunt and two penetrating chest injuries. Four patients had significant preexisting medical comorbidities. Three patients with blunt injuries had undergone exploratory thoracotomy, but continued to bleed postoperatively. In three patients, angiography was indicated for associated thoracic and pelvic injuries, and five patients had SATE specifically due to thoracic hemorrhage. In all patients, SATE was effective to diagnose and control the hemorrhage. There were no complications related to the SATE procedure. Two patients died secondary to severe cerebral injuries. Given hemodynamic stability, SATE can be considered in patients who have already had a thoracotomy, have significant associated medical conditions, or those in need of other angiographic studies. Careful technique and a readiness to abandon SATE in unstable patients or when a suitable catheter position cannot be achieved are important technical points.