Empalamiento precordial por arma blanca: extracción bajo visión videotorcoscópica / PRECORDIAL REMOVAL OF AN IMPALED KNIFE UNDER THORACOSCOPIC VISION
Prensa méd. argent
; 105(11): 783-785, dic2019. fig
Article
em Es
| LILACS, BINACIS
| ID: biblio-1049774
Biblioteca responsável:
AR392.1
ABSTRACT
Background:
It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs TA 110 / 70mmHg, FC 70min, FR 20min, Sat02 97%. Complementary studies ECO FAST no pericardial fluid. Rx thorax mild left pneumothorax heme. Chest CT Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution Derived from UTI extubated. CT scan thorax 72 h post small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day.Discussion:
The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy
Coleções:
01-internacional
Base de dados:
BINACIS
/
LILACS
Assunto principal:
Ferimentos Perfurantes
/
Dor no Peito
/
Toracotomia
/
Laparoscopia
/
Cirurgia Torácica Vídeoassistida
/
Sinais Vitais
Tipo de estudo:
Guideline
Limite:
Aged
Idioma:
Es
Revista:
Prensa méd. argent
Assunto da revista:
MEDICINA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Argentina
País de publicação:
Argentina