The use of prehospital tube thoracostomy (TT) for the treatment of suspected tension pneumothorax (TPtx) in trauma patients is controversial. A study is presented that reviews a 6-year experience with the use of needle catheter aspiration (NA) and chest tubes performed in the field by air medical personnel. Prehospital flight charts and hospital records from 207 trauma patients who underwent one or both of these procedures in the field were retrospectively reviewed. The clinical indications used to determine treatment are presented for both procedures. Improvement in clinical status of patients observed by flight personnel were similar for both treatment groups (54% for NA, 61% for TT). Thirty-two (38%) of the TT patients had failed NA attempts prior to chest tube placement. Average time on scene (T.O.S.) was significantly greater for the TT group (25.7 min versus 20.3 min for NA group). Fewer patients were pronounced dead on arrival (D.O.A.) with TT treatment compared to NA alone (7% versus 19%, respectively). Injury severity scores, number of hospital complications, length of stay (L.O.S.), and total hospital costs were not different between the two groups. There were no cases of lung damage or empyema formation associated with prehospital TT treatment. Overall mortality was similar for both groups. From these data, we conclude that NA is a relatively rapid intervention in the treatment of suspected TPtx in the prehospital setting; however, TT is an effective adjunct for definitive care without increasing morbidity or mortality. A better understanding of the physiology of intrapleural air masses is needed to determine the most effective decompression requirements prior to aeromedical transport.

Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews

Current evaluation of cardiac stab wounds

Australia's population is ageing. Statistics predict that by the year 2021, 17.8% of our population will be over the age of 65 years. These statistics are reflected in most Western nations. The elderly represent an increasing proportion of emergency department patients. They are generally more acute on presentation, they get admitted more frequently, and account for an increasing proportion of admissions to intensive care units. The elderly trauma patient will increasingly consume more resources than patients from any other age group. There are significant differences in physiology and response to trauma between the elderly patient and the young. Airway compromises, a decrease in lung compliance, a change in cardiovascular haemostasis and the prevalence of pre-existing disease all contribute to increase morbidity and mortality in a patient with an already limited physiological reserve. Many studies demonstrate an increased mortality in hospitalized elderly trauma patients. For those who die from traumatic insult, death is mainly due to multiorgan system failure. The long-term functional outcome of the elderly trauma patient has been investigated by a number of authors. One study showed that only 8% of survivors returned to independent living 1 year post-polytrauma. Another more encouraging study showed that 89% of survivors of blunt multiple trauma after 38 months were independent and living at home. Ethical issues have been raised regarding the appropriateness of care for the severely injured elderly patient given today's ever-shrinking hospital finances and bed shortages. Today's environment is very challenging as frequently, the clinician is forced to make an economic decision on who will take the last critical care bed, which is a far from optimal situation.

Trauma in the elderly: a new epidemic?

Background: Despite many published retrospective analyses on cardiac injuries in treated patients, there is a striking scarcity of population-based studies that include autopsies. Objectives: To provide data on fatal traumatic heart wounds in autopsied cases. Methods: We reviewed 2,487 medico-legal autopsy records from the morgue of the Bursa branch of the Turkish Council of Forensic Medicine for the period 1997-2001. Results: Of these cases, 160 (6.4%) had cardiac injury; 13.8% were females and 86.2% males, and the mean age was 35.9 years (range 4-65). The most common cause of heart wounds was penetrating trauma (87.5%), namely sharp injuries (48.1%) and firearm injuries (39.4%). The two most common causes of blunt heart wounds were traffic accidents (5.6%) and falls from a height (5%). Rupture was present in 96.9% of the cases, and isolated left ventricle and isolated right ventricle were ruptured in 31.3% and 23.8%, respectively. In penetrating injury the risk of ventricle rupture was higher than of atrium rupture. Alcohol was detected in 16.3% of cases. Only 3.5% of the penetrating cardiac injury cases and 5% of the blunt cardiac injury cases were admitted to hospital. Conclusions: Given that only a very low percentage of the patients who sustain cardiac injury reach hospital alive, population- based studies, especially autopsy results, should be conducted to define the characteristics of cardiac injuries. IMAJ 2005;7:498-501

/pdf/fatal-traumatic-heart-wounds-review-of-160-autopsy-cases-zuqqedrhbr.pdf

Fatal traumatic heart wounds : Review of 160 autopsy cases

Netherton's syndrome, which is classified as an ichthyosiform syndrome, is a dermatose comprising ichthyosis linearis circumflexa and/or congenital ichthyosiform erythroderma, trichorrhexis invagi- nata and atopic features. Here, we present a 56 year-old female who has polycyclic, ery- thematous, double edged scaly lesions on her trunk and limbs as well as brittle hair and bilateral alopecia on the lateral part of her eyebrows. The microscopic examination of the hair shaft showed trichorrhexis invaginata. The histopathologic examination of the lesional skin biopsy is correlated with ichthyosis linearis circumflexa. We used topical steroids and emollients for the treatment of the skin lesions and informed the patient about the prognosis of her dis- ease.

http://www.diclemedj.org/upload/sayi/21/Dicle%20Med%20J-01531.pdf

Olgu sunumu / case report

The clinical profiles and management of 236 consecutive chest injury patients treated and followed up at All India Institute of Medical Sciences between January 1983 and July 1985 were analyzed prospectively. There were 149 blunt and 87 penetrating injuries; 21 patients (9%) required thoracotomy. Single- or multiple-tube thoracostomy was performed in 141 patients (60%). The remaining 74 patients (31%) required only observation for a period of 24-48 hours. Fifteen patients (6.3%) died, the mortality being related to head injury in four, irreversible hypovolemic shock in four, pulmonary embolism in three, septicemia in two, and respiratory failure in two. Nonfatal complications included residual hemothorax in 18 cases, persistent air leak in 13, pulmonary infection in eight, pulmonary embolism in one, and empyema in one. The average hospital stay was 6.9 days. Evidence of chest injury of various magnitudes was found in 756 of 2,286 autopsies conducted for trauma-deaths during the same study period analyzed retrospectively; however, it was the major cause of death in only 147 (19%). Cardiac injuries accounted for 41% of the deaths resulting primarily from chest trauma. Only 10% of the patients who sustained cardiac injury reached hospital alive.

Chest injuries: a clinical and autopsy profile.

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Chest injuries: a clinical and autopsy profile.