RESUMO
Clamshell thoracotomy for thoracic injuries is an uncommon emergency department procedure. The survival rates following emergency thoracotomy are very low at 9%-12% for penetrating trauma and 1%-2% for blunt trauma. We report an unusual case of survival after emergency department clamshell thoracotomy for penetrating thoracic trauma with cardiac tamponade in a 23-year-old man with multiple stab wounds on the chest and abdomen. The patient was awake and alert on arrival in the emergency department. Bilateral chest decompression by needle thoracostomy released air and blood. During subsequent chest drain insertion, the patient suddenly deteriorated and arrested. Clamshell thoracotomy was performed, and sinus rhythm restored before transfer to theatre. Following repair of the thoracic injuries, a midline laparotomy was performed as bleeding was suspected from the abdomen and a splenic injury repaired. The patient survived and has made a full recovery. This case demonstrates how clamshell thoracotomy can be a life-saving procedure.
Assuntos
Traumatismos Abdominais/cirurgia , Laparotomia , Baço/cirurgia , Traumatismos Torácicos/cirurgia , Toracotomia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/patologia , Tratamento de Emergência/métodos , Humanos , Escala de Gravidade do Ferimento , Laparotomia/métodos , Masculino , Baço/lesões , Traumatismos Torácicos/patologia , Toracotomia/métodos , Resultado do Tratamento , Ferimentos Penetrantes/patologia , Adulto JovemRESUMO
Blunt neck trauma can be caused by a variety of injuries such as deceleration, road traffic accidents and crush injuries. The worst scenario is airway rupture. We report an unusual case of acute tracheal injury in a 34-year-old Irish man who presented with a history of strangulation while working with a tractor. On arrival, he had one episode of mild haemoptysis and reported pain around the base of the neck and voice hoarseness. His chest X-ray revealed pneumopericardium and CT of thorax showed airway oedema. After elective intubation, positive end-expiratory pressure (PEEP) of 5 cm H2O caused deterioration in his clinical condition with increasing surgical emphysema and rise of carbon dioxide partial pressure (PaCO2), which was completely reversed after stopping PEEP. This case shows how PEEP and intermittent positive pressure ventilation can worsen air leak and compromise stability in patients with acute tracheal injury.