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Wed Nov 1 10:07:51 GMT 2006

Immediate thoracotomy

Richard van der Kleyn wrote:

> Dear list,
> would like your coments on a recent case as i am planning to review
> the case for lessons learned:
>
> 39 year old female, penetrating injury from a knife right posterior
> torax level 6/7 rib. Found on the streat, brought in to our small
> hospital by the ambulance (personal not qualified for bringing in
> infusions- unfortunatly the medicalized ambulance was occupied with an
> MI), pacient entered our ED following signs: A- clear B/ sat 80%,
> dimished breath sounds right hand side C/ pulse 130 RR 80/30 (class 3
> shock). D glasgow 9 (hipoperfusion).
> RxTorax: hematotorax right hand side, pneumotorax right hand side with
> shift of of the mediastinum tio the left.
> Pacient was intubated while the surgeon placed a chest tube right hand
> side which produced 1,500-2000 ml blood and air.
> Libral fluid infusion first o negative then type specific without
> respons (4 concentrats and 2 L saline)- tensions remain same.
>
> At this moment ther is a medicalized ambulance waiting to bring the
> pacient to the nearest trauma center (35-40 minutes). Ours is a small
> hospital, 1 surgeon who happened to be new but with some experiance in
> toractomy, last toracotomy performed about 8 years ago
>
> question: toractomy or transport to traumacenter   (easy answer for
> people who deal with these cases everyday)
>
>
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penetrating posterior torax injury