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chest injury

Dorothee Boehm, Konstantin Bergmeister, Emre Gazyakan, Thomas Kremer, Ulrich Kneser, Volker J Schmidt
AIMS: Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh. METHODS: We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury...
March 13, 2018: Annals of Plastic Surgery
John H Harris, William H Harris, Sanjay Jain, A Y Ferguson, David A Hill, Amy M Trahan
PURPOSE: CTA is routinely ordered on level II blunt thoraco-abdominally injured patients for assessment of injury to the thoracic aorta. The vast majority of such assessments are negative. The question being asked is, Does the accurate interpretation of the three mediastinal signs permit reliable determination of which patients need CTA for aortic assessment? The purpose of this investigation was to evaluate the role of three specifically selected mediastinal anatomic signs on the initial supine chest radiograph (CXR) of adult level II blunt thoraco-abdominally injured patients for the presence or absence of a mediastinal hematoma...
March 13, 2018: Emergency Radiology
Andrew T Koogler, Michael Kushelev
A 76-year-old male presented for reverse total shoulder arthroplasty (TSA) in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy...
2018: Case Reports in Anesthesiology
Sakshi Mathur Dhar, Matthew D Breite, Stephen L Barnes, Jacob A Quick
BACKGROUND: Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity. METHODS: We conducted a single-center, retrospective review of 163 severely injured trauma subjects (injury severity score ≥ 15) with severe thoracic injury (chest abbreviated injury score ≥ 3), who required mechanical ventilation for >24 h at a verified Level 1 trauma center...
March 13, 2018: Respiratory Care
James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
E A Almeida, A C Sant'Anna, T G Crowe, M Macari, R L Furlan
Previously, we reported the effect of rearing conditions (plastic floors and air quality) on carcass injury development of broiler chickens at thermal comfort. In this study, the same rearing conditions were tested at thermal stress. The birds were reared in 2 climatic chambers, and the experiment followed a completely randomized design with one factor, flooring material: wood shaving or perforated plastic. The birds were divided into 16 experimental pens, being 8 females and 8 males. The studied parameters were the same as the previous study (ammonia concentration, carbon dioxide, performance, carcass yield, and variability, and scores of hygiene, gait and chest, and hocks and footpad lesions)...
March 8, 2018: Poultry Science
Tsunehiko Konomi, Kota Suda, Satoko Matsumoto, Miki Komatsu, Masahiko Takahata, Norimasa Iwasaki, Akio Minami
Introduction: There are considerable risks for vertebral artery (VA) injury in case of corrective surgery for a severe and rigid cervical kyphotic deformity. This case report describes a rare case of surgical management for pre-existing traumatic rigid cervical kyphosis associated with unilateral VA occlusion. Case presentation: A 73-year-old male fell down and injured his neck. He was referred to our hospital 10 months after injury because his degree of head drop progressed gradually to a chin-on-chest position such that he could not look straight forward...
2018: Spinal Cord Series and Cases
Simon Laurent, Olivier Martinet, Helene Cuq, Alain Rind, Philippe Durasnel, Claire Lenne, Renaud Blondé
Stingray injuries to the chest are rare but potentially life-threatening. They may occur in remote areas where advanced emergency healthcare services are unavailable. We describe the case of a 24-year-old man with tension pneumothorax due to a Himantura fai stingray injury to the left chest. The chest wound was unremarkable, with no external bleeding or evidence of a foreign body. Decompression was performed at the scene with an improvised knife procedure and a hollow writing pen, which served as a chest tube...
March 9, 2018: Wilderness & Environmental Medicine
Manuel F Struck, Sebastian Ewens, Wolfram Schummer, Thilo Busch, Michael Bernhard, Johannes K M Fakler, Patrick Stumpp, Sebastian N Stehr, Christoph Josten, Hermann Wrigge
PURPOSE: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. METHODS: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015...
March 1, 2018: Journal of Vascular Access
William Bortcosh, Ashkon Shaahinfar, Sakina Sojar, Jean E Klig
PURPOSE OF REVIEW: The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research. RECENT FINDINGS: POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration...
March 9, 2018: Current Opinion in Pediatrics
Shyam Kumar, Ulhas Sonar, Iqbal Singh
The incidence of fragility fractures of the humerus is increasing worldwide. Although clinicians are aware of fractures of hips and wrists, fractures of the shoulder and elbow do not receive much attention. A considerable proportion of the elderly population (estimated at 10-24%) is dependent on walking aids. A well-functioning and pain-free shoulder and elbow is essential for use of these aids. The impact of loss of mobility in the elderly is well known, hence the overall impact of these fractures on the individual can be considerable...
March 2, 2018: British Journal of Hospital Medicine
Morgan Schellenberg, Kenji Inaba, James M Bardes, Nicholas Orozco, Jessica Chen, Caroline Park, Tarina Kang, Demetrios Demetriades
BACKGROUND: Portable chest x-ray (CXR) and extended FAST (EFAST) screen patients for thoracic injury in the trauma bay. It is unclear if one test alone is sufficient, if both are required, or if the two investigations are complementary. Study objectives were to define the combined diagnostic yield of EFAST and CXR among stable blunt thoracic trauma patients and to determine if a normal EFAST and CXR might obviate the need for CT scan of the chest. METHODS: All blunt trauma patients ≥15 years presenting to LAC+USC Medical Center in 2016 were screened...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Nicholas R Phillips, Derek E Kunz
While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax...
March 2018: Current Sports Medicine Reports
Susan Yoong, Ravi Kothari, Adam Brooks
INTRODUCTION: Whole body computed tomography has become standard practice in many centres in the management of severely injured trauma patients, however, the evidence for it's diagnostic accuracy is limited. AIM: To assess the sensitivity of whole body CT in major trauma. METHOD: Retrospective review of all patients with injury severity score (ISS) > 15 presenting with blunt trauma to a UK Major Trauma Centre between May 2012 and April 2014...
March 8, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Ana Rita G Francisco, José Duarte, Eduardo Infante de Oliveira
Several types of intravascular devices and catheters are frequently used for long-term drug therapy, especially for oncological patients. As a result, complications are becoming increasingly common, namely catheter embolization. Retrieving these devices is important, as embolized fragments may lead to serious consequences, such as arrhythmias, myocardial injury, thrombosis, infection, and even perforation and death. We describe 2 cases of long-term drug catheter (Port-A-Cath) fracture, incidentally documented in a routine chest radiograph...
January 1, 2018: Vascular and Endovascular Surgery
Wataru Takayama, Hazuki Koguchi, Akira Endo, Yasuhiro Otomo
OBJECTIVES: The aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces...
March 8, 2018: Prehospital and Disaster Medicine
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma (CRTT) is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries are the most common mechanisms of trauma to the chest. Imaging plays a key role in the battlefield management of CRTT casualties. This work discusses the imaging manifestations of thoracic injuries from blunt trauma and blast injury, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
Grace Koo, Neha Goyal, Jeanne M DeCara, Roberto M Lang, Karima Addetia
Good-quality chest compressions improve outcomes in cardiac arrest. While manual chest compressions are suboptimal in this regard, the LUCAS device has been shown to improve the effectiveness of chest compressions during cardiopulmonary resuscitation (CPR). The complication rate associated with mechanical CPR, however, has not been adequately studied. Limited evidence suggests no difference in internal injury between manual and mechanical CPR. We report the case of a patient on anticoagulation who developed a mediastinal hematoma post mechanical CPR and on whom subtle findings on initial echocardiography could have alerted the clinician to this complication early during the clinical course...
March 6, 2018: Echocardiography
Jia Wei, Rui-Xia Yang, Qin Ye, Xue-Lian Xiao, Xiao-Ling Zang, Zhong-Jian Zhao, Zhen-Zhen Cai, Min Wang, Jian Xu, Li Jiang
BACKGROUND: High level of red blood cell distribution width (RDW) has been associated with adverse outcomes in coronary artery disease patients. We aimed to investigate the relationship between RDW and the risk of myocardial injury in chest pain patients. METHODS AND RESULTS: We retrospectively reviewed 2078 chest pain patients with suspected acute myocardial infarction. Myocardial injury was defined as high-sensitivity cardiac troponin T (hs-cTnT) >14 ng/L...
March 3, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
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