Conservative management of traumatic pneumothoraces: A retrospective cohort study.

OBJECTIVE: Traumatic pneumothoraces (T-PTXs) are traditionally managed with an intercostal catheter (ICC), despite little evidence for this. Success with conservative management of primary spontaneous PTX has been demonstrated, and our ED has adopted a conservative approach where safe for all PTX. METHODS: We reviewed all T-PTXs at our institution over a 7-year period to assess outcomes of those conservatively managed and compare with those who received an ICC. A total of 144 cases were identified, 65 managed conservatively and 79 invasively. Each was individually reviewed and variables including demographics, aetiology, smoking/lung disease history, T-PTX size (apical interpleural distance and hemithorax percentage), length of stay, Revised Trauma Score, Injury Severity Score and delayed intervention/complications were recorded. Chi-squared, Z-score, Mann-Whitney U and t-tests were used for analysis. RESULTS: The mean apical interpleural distance was 26.8 mm (95% confidence interval [CI] 22.1-29.7 mm) in the conservative group and 49.1 mm (95% CI 41.2-57.0 mm) in the ICC group (P < 0.05 for difference between groups). Mean T-PTX percentage 25.9% (95% CI 22.1-29.7%) in the conservative group versus 45.9% (95% CI 39.7-50.5%) in the ICC group (P < 0.05 for difference between two groups) and mean Revised Trauma Score 7.4 (conservative) versus 6.8 (invasive) (P < 0.05). No conservatively managed patient required a delayed intervention for their T-PTX, and 2 of 79 (3%) patients in the ICC group had a complication (one infection, one haemothorax). CONCLUSION: Our data support conservative management of selected T-PTXs and shows a need for a prospective randomised trial to further examine this intervention.

A rare case report of small bowel obstruction following colonoscopy.

Bowel obstruction following colonoscopy is very rare. We present a case of a 53-year-old female who underwent elective colonoscopy and haemorrhoidectomy. She developed generalized abdominal pain and distension with CT findings suggestive of small bowel obstruction. The patient underwent an emergency laparotomy, which revealed ischemic small bowel which had internally herniated through an adhesional band around cecum. Bowel ischemia recovered following adhesiolysis and the patient was spared from having a bowel resection. She recovered well after 2 days in ICU. We present a very rare case of small bowel obstruction following routine colonoscopy.

Acute ST-elevation myocardial infarction in a 24-year-old woman with atheromatous coronary artery disease.

We report the case of a 24-year-old Torres Strait Islander woman who presented to a rural hospital ED with chest pain suspicious for myocardial ischaemia and was found to have an anterior ST-elevation myocardial infarction. She was thrombolysed and transferred to a tertiary centre where subsequent angiography revealed atheromatous disease of the left anterior descending coronary artery. We believe this to be one of the youngest reported cases of myocardial infarction due to atheromatous coronary artery disease, and demonstrates important learning points regarding the demographics and risk factors of indigenous patients with chest pain.