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Emergency department thoracotomy & lung injury

emergency department thoracotomy & lung injury

Mande Toubkin, National Trauma Coordinator, Netcare, South Africa

Penetrating cardiac injury. Temporary balloon occlusion urinary catheter

Penetrating cardiac injury. Temporary balloon occlusion urinary catheter.

Ricardo Antonio Hoppen, Passo Fundo, Rio Grande do Sul, Brazil

Stab wounds to back

Multiple stab wounds to back

Harry Voesten, Netherlands

Stab wounds to back - front view

Stab wounds to back

Harry Voesten, Netherlands

Shotgun wound to chest - lung injury at thoracotomy

Shotgun wound to left chest

Luis Filipe Pinheiro, Hospital S㯠Teot󮩯, Viseu, Portugal

Shotgun wound to chest

Shotgun wound to left chest

Luis Filipe Pinheiro, Hospital S㯠Teot󮩯, Viseu, Portugal

Gunshot wound to right lung, right atrium / suprahepatic IVC 01

Gunshot wound to right lung middle lobe

trauma.org

Gunshot wound to right lung, right atrium / suprahepatic IVC 02

Gunshot to right atrium / IVC

trauma.org

Gunshot wound to right lung, right atrium / suprahepatic IVC 03

Grade 3 spleen injury following motor vehicle collision

Grade 3 spleen injury following MVC

Roy Danks, Northeast Regional Medical Center, Kirksville, MO

Mesh splenorraphy of Grade 3 spleen injury

Roy Danks, Northeast Regional Medical Center, Kirksville, MO

Grade 2 liver injury - gunshot wound - entrance

Ronald Stewart

Grade 2 liver injury - gunshot wound - exit

Ronal Stewart

Gunshot wound to right flank - liver injury

Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

Grade 3 liver injury - gunshot wound 01

Grade 3 liver injury - gunshot wound

Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

Grade 3 liver injury - gunshot wound 02

Grade 3 liver injury - gunshot wound

Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

Gunshot liver - balloon tamponade

Jack Sava, Washington Hospital Center, Washington, D.C.

Gunshot colon

Gunshot injury to colon

trauma.org

Gunshot to Abdomen. Entry wound. IVC Injury

Gunshot wound: Entry in right upper quadrant.

Luis Pinheiro. Viseu, Portugal

Right medial visceral rotation. IVC Injury.

Right medial visceral rotation for IVC injury

Luis Pinheiro. Viseu, Portugal

Gunshot wound to stomach. Suture repair.

Repair of gunshot wound to anterior stomach.

Luis Pinheiro. Viseu, Portugal

Gunshot to Infrahepatic IVC: Lateral Repair

Lateral repair of gunshot wound to infrahepatic IVC

Luis Pinheiro. Viseu, Portugal

Abdominal gunshot wound. Bullet in retroperitoneum.

Bullet lying in retroperitoneum between IVC and Kidney

Luis Pinheiro. Viseu, Portugal

Through & through gunshot wound to liver, Grade 4

Through & through gunshot liver

Carlos Zavaleta, Hospital Nacional de Soyapango, San Salvador, El Salvador

Through & thourgh liver injury with foley catheter balloon control

Foley catheter tamponade of gunshot liver

Carlos Zavaleta, Hospital Nacional de Soyapango, San Salvador, El Salvador

Cholangiogram of biliary fistula in gunshot liver injury

Cholangiogram showing biliary tree

Carlos Zavaleta, Hospital Nacional de Soyapango, San Salvador, El Salvador

Balloon tamponade of liver laceration

Balloon tamponade of gunshot liver injury

Jorge Carlotto, Passo Fundo, Rio Grande do Sul, Brasil

Complex skull & facial fractures - CT02

CT Brain of crushed skull

Leonardo Hassegawa, Curitiba, Brazil

Complex skull & facial fractures - CT01

Complex skull fracture - CT reconstruction

Leonardo Hassegawa, Curitiba, Brazil

Liver injury with foley catheter balloon control. Foley in place - biliary fistula

Foley catheter controlling biliary fistula

Carlos Zavaleta, Hospital Nacional de Soyapango, San Salvador, El Salvador

Biliary fistula from gunshot wound to liver

Biliary fistula from liver gunshot wound

Carlos Zavaleta, Hospital Nacional de Soyapango, San Salvador, El Salvador

Nailgun Injury to Forehead

Nail removed from frontal skull

Craig J. Huang, MD

Gunshot Hand (accidental)

Gunshot hand entry & exit wounds

Flying Doctor Service, AMREF, Kenya

Penetrating Neck Injury with Oesophageal Laceration 01

Neck exploration for oesophageal injury

Nícolas Leal, Maurício Mentz, Jorge Mentz, Jorge Carlotto e Rodrigo de Oliveira – Hospital da Cidade, Passo Fundo – Rio Grande do Sul, Brasil.

Penetrating Neck Injury with Oesophageal Laceration 02

Oesophageal laceration

Nícolas Leal, Maurício Mentz, Jorge Mentz, Jorge Carlotto e Rodrigo de Oliveira – Hospital da Cidade, Passo Fundo – Rio Grande do Sul, Brasil.

Penetrating Neck Injury with Oesophageal Laceration 03

Resection of oesophageal injury

Nícolas Leal, Maurício Mentz, Jorge Mentz, Jorge Carlotto e Rodrigo de Oliveira – Hospital da Cidade, Passo Fundo – Rio Grande do Sul, Brasil.

Penetrating Neck Injury with Oesophageal Laceration 04

Oesophagostomy for oesophageal injury

Nícolas Leal, Maurício Mentz, Jorge Mentz, Jorge Carlotto e Rodrigo de Oliveira – Hospital da Cidade, Passo Fundo – Rio Grande do Sul, Brasil.

Gun Shot to the Abdomen

Gunshot abdomen - entry wound

Dr. Nedal Matar, Aleppo University Hospital, Syria

Dog bite to forearm

Dogbite to forearm

Luis Velazco M.D, Mery Cortes M.D, Barquisimeto, Venezuela

Jejunal gunshot wound

Through and through gunshot to the jejunum.

Dr. Nedal matar, Aleppo University Hospital, Syria

Primary anastomosis of jejunal injury

Segemental Resection of Jejunum with Primary Anastomosis

Dr. Nedal Matar, Aleppo University Hospital, Syria

Stab Wound to the Abdomen

Stab Wound to the Abdomen, with omental protrusion.

Dr. Nedal Matar, Aleppo University Hospital, Syria.

Penetrating jejunal injury with evisceration 01

Jejunal laceration and evisceration

Leonardo Hassegawa, Curitiba, Brazil

Penetrating jejunal injury with evisceration 02

Jejunal laceration and evisceration

Leonardo Hassegawa Curitiba - Brazil

Dog Bite to Forearm 02

Dog bite to forearm

Luis D. Velazco M.D, Mery Cortes M.D Barquisimeto Venezuela

Caecal evisceration following stab wound

Jorge Carlotto, Hospital da Cidade, Passo Fundo, Rio Grande do Sul, Brasil.

Impaled object at ankle joint

Impalement through ankle joint

K.S. Chew, Lecturer/Clinical Specialist, Dept. of Emergency Medicine, School of Medical Sciences, University Sains Malaysia

Gunshot to mandible with bullet fragments - Lateral X-ray

Gunshot wound to mandible - lateral X-ray

Herb Phelan, Brian Eastridge, Parkland Memorial Hospital, Dallas, Texas

Gunshot wound to carotid artery - operative - 01

Herb Phelan, Brian Eastridge, Parkland Memorial Hospital, Dallas, Texas

Gunshot wound to carotid artery - operative - 02

Herb Phelan, Brian Eastridge, Parkland Memorial Hospital, Dallas, Texas

Gunshot wound to carotid artery - operative - 03

Herb Phelan, Brian Eastridge, Parkland Memorial Hospital, Dallas, Texas

Gunshot wound to carotid artery - post-operative

Herb Phelan, Brian Eastridge, Parkland Memorial Hospital, Dallas, Texas

Thoracic gunshot - retroaortic bullet 01

Lung contusion & pneumothorax from gunshot

trauma.org

Thoracic gunshot - retroaortic bullet 02

Anterior column vertebral fracture (gunshot)

trauma.org

Thoracic gunshot - retroaortic bullet 03

Retroaortic bullet

trauma.org

Midbrain contusion

Nelson Morales, Neurosurgeon, Villavicencio-Colombia

Abdominal Stabbing

X-Ray showing knife blade in situ.

Leonardo Hassegawa, Curitiba - Brazil

Abdominal Stabbing - Removed blade

Removed Blade

Leonardo Hasseagawa - Curitiba, Brazil

Cerebral Hemispheric Infarct Despite Decompressive Craniectomy

Hemispheric Infarct Despite Decompressive Craniectomy

Craig J. Huang, MD, Pediatric Emergency Medicine Attending Children's Medical Center of Dallas

Colon injury from air gun pellet in a 5 year old

Colon perforations from airgun injury in a 5-year old.

Fernando Joglar, MD, Subdirector, Puerto Rico Trauma Center, San Juan, Puerto Rico

Suprasternal notch stab wound

Zone 1 stab wound to neck.

Fernando Joglar, MD, Subdirector, Puerto Rico Trauma Center, San Juan, Puerto Rico

Gunshot wound to the kidney

Gunshot to left kidney

Carlos Zavaleta, Hospital Nacional de Soyapango, San Salvador, El Salvador.

Penetrating abdominal trauma - knife in situ

Penetrating abdominal injury - knife in situ

Dr. Daniel Maia, Hospital Geral do Grajaú, São Paulo, Brazil.

Retroaortic gunshot wound

Fernando Joglar, MD Puerto Rico Trauma Center

Stab Wound to the heart - Sternotomy & Balloon Occlusion

Fogarty Catheter Ballon Occlusion of Right Ventricle Stab Wound

Juan Duchesne, NO, Tulane

Stab Wound to the Heart = Balloon Occlusion of Right Ventricle Wound

Ballon Occlusion Right Ventricle Stab Wound

Juan C Duchesne MD, NO, Tulane

Liver Explosion

Grade V liver injury from gunshot

Luis Filipe Pinheiro Hospital S. Teotónio - VISEU PORTUGAL

Abdominothoracic trauma due to impalement by an iron bar

Abdominal and thoracic trauma caused by iron bar impalement

Dr Biplab Mishra

Abdominothoracic trauma due to impalement by an iron bar

Abdominal and thoracic trauma caused by iron bar impalement

Dr Biplab Mishra

Liver and Kidney 01

Gunshot Kidney - IVU

Carlos Zavaleta

Liver and Kidney 02

Gunshot Liver Grade 4

Carlos Zavaleta

Liver and Kidney 03

Gunshot Kidney - Grade 4 injury

Carlos Zavaleta

Liver and Kidney 04

Gunshot kidney - nephrectomy

Carlos Zavaleta

Liver and Kidney 05

Liver injury post pack removal

Carlos Zavaleta

Liver and Kidney 06

Gunshot liver - inferior view

Carlos Zavaleta

A hazard of in-car entertainment

Dr David Hunter and Mr Keith Mulholland. Altnagelvin hospital Londonderry Northern Ireland

Emergency Department Thoracotomy

ED thoracotomy on a patient post firearm injury with damage to the ascending aorta

Vicente Scopel, Jorge Carlotto e Danielle Negrello. Serviço de Cirurgia Geral e do Trauma do Hospital da Cidade - Passo Fundo - RS - Brasil

Partial ear avulsion

A partial left pinna avulsion

Sushma Sagar, AIIMS, Delhi

Bullet lodged in Penis

Radiograph showing a bullet lodged within the penis

Guillermo García S, MD. Santiago, Chile.

Multiple stabbing to the back

Stab wounds to the back

Shotgun wound to the chest with haemothorax

Shotgun wound to the chest. Haemothorax

Trauma.org

Thoracotomy following shotgun wound to the chest

Thoracotomy following shotgun to the chest

Trauma.org

A lower leg fracture with arterial injury

Fractured tibia and fibula

R.N. Jaime E. Castellanos, Venezuela

Articles

Peripheral Vascular Trauma

, March 07, 2002

Peripheral Vascular Trauma
Karim Brohi, trauma.org 7:3, March 2002

Introduction

Vascular injury has two main consequences - haemorrhage and ischaemia. Or, in the words of an anonymous…

Penetrating Neck Injury

, June 07, 2002

Penetrating Neck Injury

Karim Brohi, trauma.org 7:6, June 2002

Introduction

The management of penetrating neck trauma has changed over the past two decades from mandatory exploration of…

Penetrating Abdominal Trauma: Guidelines for Evaluation

charles krin, Karim Brohi, London, UK, August 09, 2004

Abdominal Trauma
Evaluation of Penetrating Abdominal Trauma

Penetrating abdominal injury

The abdomen extends from the nipples to the groin crease anteriorly, and the tips of the scapulae to the…

Acute management of Traumatic Brain Injury

, November 28, 2006

Acute Management of Traumatic Brain Injury

Management of traumatic brain injury focuses on stabilisation of the patient and prevention of secondary neuronal injury to avoid further loss of neurons.…

Revised Trauma Score

Revised Trauma Score and Desktop Calculator

Karim Brohi, London, UK, March 10, 2007

Introduction

The Revised Trauma Score is a physiological scoring system, with high inter-rater reliability and demonstrated accuracy in predicting death. It is scored from the first set…

Indications for Bullet Removal

The rare cases where bullet removal is justified

Karim Brohi, London, UK, July 27, 2007

The Trauma-list recently discussed when, if ever, bullet removal was indicated. Here are the conclusions, which an illustrative case.

Organ Injury Scaling - Kidney

AAST Organ Injury Scale - Kidney

, February 16, 2009

AAST Organ Injury Scale Scores for the Kidney - matched to AIS-90 codes. Use Abbreviated Injury Scale Scores (AIS) for Injury Severity Scoring (ISS).

Pneumothorax

An overview of pneumothoraces - diagnosis & management

, May 09, 2009

Diagnosis & management of simple pneumothorax

Haemothorax

Chest Trauma Haemothorax

, September 30, 2010

Haemothorax

Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma. Most haemothoraces are the result of rib fractures, lung parenchymal and minor venous injuries, and as such are self-limiting. Less commonly there is an arterial injury, which is more likely to require surgical repair.

Case Presentations

An Iliac Nutrient Foramen Bleed in The Delayed Revision of an Acetabular Fracture

Jianshun Wang, November 18, 2011

Despite the challenges of delayed revision of acetabular fractures, severe haemorrhage leading to haemodynamic instability is not often encountered. Immediate intraoperative detection and cessation of the bleeding source is vital. We present a case highlighting an iliac nutrient foramen haemorrhage which almost resulted in a lethal haemorrhage during an open reduction of a delayed ace tabular fracture via the ilioinguinal approach.

Bilateral lower extremity gunshot wound with arterial and venous injury

Gunshot injury to both lower limbs requiring vascular damage control

sam zeraatian nejad davani, December 26, 2010

20 years old man after civilian gunshot wound, arrived in our emergency department with profound shock and ongoing bleeding from gunshot wounds to both thighs.

Fracture-dislocation of the thoracolumbar spine with multiple injuries

Cedillo J., Bolaños R.

Jesús Cedillo, Mexico, September 24, 2010

A 45 year old patient fell 3.5metres and sustained a fracture-dislocation of the thoracolumbar spine together with head, chest and abdominal injuries

Biventricular shotgun injury of the heart

with involvment of proximal RCA and LAD

sam zeraatian nejad davani, July 31, 2010

20 years old man came with profound shock and bilateral massive hemothorax and jugular vein distension as result of cardiac tamponade. He underwent successful cardiac repair and had an uneventful post operative course.

Penetrating Cardiac Injuries

How to get the best possible outcome?

Denis Allard, GF Jooste hospital Manenberg, January 10, 2009

82% survival in 35 consecutive stab heart patients was achieved in a South African metropolitan community hospital during the year 2008. Excellent and expediant prehospital management, skilled emergency room personnel and available surgical skill is necessary to achieve these results. The survival rate depends on the number of patients analyzed. The last 160 patients have a 70% survival rate, the last 35 patients have an 82% survival rate. Every surgical team can achieve good results under appropriate leadership.

Gunshot to Carotid Artery

Gunshot carotid artery: angiogram & vein graft repair

Herb Phelan, Parkland Memorial Hospital, Dallas, TX, USA, July 10, 2007

A gunshot wound to the left neck, disrupting the internal and external carotid arteries. Operative repair with reversed vein graft.

Research Blog Entries

Prehospital rapid sequence intubation improves functional outcome for severe traumatic brain injury

Karim, London, UK, January 08, 2011

PubMed ID: 21107105
Ann Surg. 2010 Dec;252(6):959-65.
Authors: Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, Walker T, Std BP, Myles P, Murray L, David, Taylor, Smith K, Patrick I, Edington J, Bacon A, Rosenfeld JV, Judson R.

Abstract:

OBJECTIVE: To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital.

BACKGROUND: Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes.

METHODS: In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge.

RESULTS: A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge.

CONCLUSIONS: In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.

Physical exercise and cognitive recovery in acquired brain injury: a review of the literature.

Karim, London, UK, July 26, 2009

PubMed ID: 19627946
PM R. 2009 Jun;1(6):560-75
Authors: Devine JM, Zafonte RD.

Abstract:

OBJECTIVE: Physical exercise has been shown to play an ever-broadening role in the maintenance of overall health and has been implicated in the preservation of cognitive function in both healthy elderly and demented populations. Animal and human studies of acquired brain injury (ABI) from trauma or vascular causes also suggest a possible role for physical exercise in enhancing cognitive recovery. DATA SOURCES: A review of the literature was conducted to explore the current understanding of how physical exercise impacts the molecular, functional, and neuroanatomic status of both intact and brain-injured animals and humans. STUDY SELECTION: Searches of the MEDLINE, CINHAL, and PsychInfo databases yielded an extensive collection of animal studies of physical exercise in ABI. Animal studies strongly tie physical exercise to the upregulation of multiple neural growth factor pathways in brain-injured animals, resulting in both hippocampal neurogenesis and functional improvements in memory. DATA EXTRACTION: A search of the same databases for publications involving physical exercise in human subjects with ABI yielded 24 prospective and retrospective studies. DATA SYNTHESIS: Four of these evaluated cognitive outcomes in persons with ABI who were involved in physical exercise. Three studies cited a positive association between exercise and improvements in cognitive function, whereas one observed no effect. Human exercise interventions varied greatly in duration, intensity, and level of subject supervision, and tools for assessing neurocognitive changes were inconsistent. CONCLUSIONS: There is strong evidence in animal ABI models that physical exercise facilitates neurocognitive recovery. Physical exercise interventions are safe in the subacute and rehabilitative phases of recovery for humans with ABI. In light of strong evidence of positive effects in animal studies, more controlled, prospective human interventions are warranted to better explore the neurocognitive effects of physical exercise on persons with ABI.