Tension pneumopericardium in a polytrauma patient.

INTRODUCTION: Tension pneumopericardium is a life-threatening condition, manifesting most commonly as hemodynamic instability caused by cardiac tamponade. Reduced cardiac output and blood pressure can lead to difficulties in the detection of arterial bleeding from associated injuries while the increased venous pressure can increase the rate of bleeding. CASE REPORT: This is the case of a patient after a car accident, with bilateral serial fractures, bilateral pulmonary contusion, bilateral pneumothorax, emphysema of the neck and chest, pneumomediastinum and pneumopericardium, and other injuries. During treatment, the patient developed a gradually progressing hemodynamic instability, resulting in pulseless electrical activity. Further progression of the case is detailed in the paper. CONCLUSIONS: Tension pneumopericardium is a rare complication of a high-energy blunt thoracic trauma that manifests through hemodynamic instability. Its treatment requires early diagnosis and immediate decompression of the pericardial cavity, which should, where possible, be performed even before putting the patient on mechanical ventilation as ventilation bears a high risk of worsening the pneumopericardium due to the increased air pressure in the lungs. During diagnosis and treatment of associated injuries, we must bear in mind that the hemodynamic changes caused by pneumopericardium can mask typical signs of such injuries.

Tension Hemothorax in Aortic Rupture: A Case Report.

Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.

Local transcutaneous cooling of the spinal cord in the rat: effects on long-term outcomes after compression spinal cord injury.

This study tested efficiency of a novel thermoelectric cooler for local transcutaneous spinal cord cooling. Spinal cord compression was made by epidural balloon inflation at T8-T9 level of the spinal cord. Experimental animals (n=20) were divided into two groups. In the hypothermic group, local cooling started 25 min after spinal cord injury and lasted for 1 h with paravertebral temperature maintained at 28.5 degrees C (+/-0.3). Normothermic group underwent identical procedures, but their temperature was maintained normothermic. The assessment of neurologic recovery was performed once a week during a 4 weeks survival period. After 4 weeks animals were sacrificed and the extent of the spinal cord lesion morphometrically evaluated. There were no statistically significant intergroup differences in BBB scores and preserved volumes of the spinal cord tissue. In consecutive cross-sectional areas, hypothermic animals had significantly more preserved white matter at the cranial periphery of the lesion. It was concluded that mild posttraumatic hypothermia (31.8 degrees C) had some protective effect on tissue loss after spinal cord injury but this effect was not associated with functional improvement.