Thoracic surgical trauma - abstract

ABSTRACT

The subject of this paper is based on the experiences during a five-year period of treating patients with respiratory distress in a general surgical unit in San Fernando, Trinidad. These patients required to have surgical intervention by one form or other. They were cases of thoracic surgical trauma. Of 120 cases of thoracic surgical trauma, 35 cases required some form of intervention. There were five cases of stove-in chest, two (2) cases of haemopericardium, five (5) cases of haemothorax and nineteen (19) cases of pneumothorax. Most of these were associated with blunt trauma, whilst the rest were associated with pellets, bullets or stabbing weapons. In the cases of pulmonary and/or pleural abnormalities, it is the resulting derangement of physiology which cause severe and urgent symptoms. These are mainly due to collapse of lung, shift of mediastinum, decrease in circulation of oxygenated blood. In the addition, there may be injury and fracture of the bony thoracic cage, which will aggravate such symptoms. When such bony injury occurs in two (2) places and over a large extent of the chest wall, stove in chest ensues. In cases of haemopericardium, the classical symptoms of cardiac tamponade ensue. These include rising venous pressure, falling arterial pressure and a quit heart. The diagnosis of the exact abnormality is most important and urgent as a satisfactory outcome depends on accurate diagnosis and treatment. Considerable use is made of X-rays and good X-rays are most important. As accurate as these may be, however, great reliance is placed upon the results of aspirating the pleural and/or pericardial cavities. The resulting aspirate with the interpretations of X-rays form the basis of accurate diagnosis. The use of indwelling intercostal catheter and open surgery for the primary condition or for its complication are used. Tracheostomy and internal fixation of the bony chest wall with various forms of tractions are utilized for the case of stove-in chest(AU)