Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewContinuous-flow rotary left ventricular assist devices with "3rd generation" design.
Left ventricular assist device (LVAD) therapy has become an established treatment option for patients with advanced heart failure. Broader application of this therapy has been limited by the risk profile of the current generation of devices. The development of continuous-flow rotary pump technology with noncontact bearing design offers the promise of improved device durability and safety profile. Clinical evaluation of these innovative pump designs are currently underway.
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The multiply injured patient with significant thoracic and extra-thoracic injuries poses a number of challenges. Pericardial tamponade, tension pneumothorax and massive hemothorax can and should be diagnosed clinically. ⋯ Beta-blockade of patients with blunt thoracic aortic injuries can be used as a temporizing damage control measure when the risks of operation or intervention are very high (traumatic brain injury, severe right or bilateral pulmonary contusion, unstable pelvic fractures). Patients with multiple penetrating wounds require the surgical team to be expeditious and flexible, and damage control is a helpful strategy in these patients.
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Emergency department thoracotomy (EDT) is defined as a thoracotomy performed in the emergency department for patients who are in extremis. The goals of the procedure are to treat pericardial tamponade, control hemorrhage, treat systemic air embolism, perform open cardiac massage and temporarily occlude the thoracic aorta. ⋯ In this brief review, we summarize the available literature, technical concerns and indications for the procedure. We aim to provide suitable information for individual readers to refine their approach to EDT.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
Combat casualty care in an air force theater hospital: perspectives of recently deployed cardiothoracic surgeons.
Current military operations have generated a large number of casualties and have led to the establishment of the first Air Force Theater Hospital since Vietnam. Located at Balad Airbase, Iraq, this hospital is a busy trauma center. Thoracic injuries are relatively infrequent but highly lethal. ⋯ Mortality from combat injury in this conflict is lower than in prior wars. Body armor may prevent some fatal injuries. Several features of military medical care process are helping to improve our outcomes-specifically, the development of a trauma care system modeled on successful civilian centers, the expanded use of damage control concepts, and utilization of early transportation out of the theater of operations using Critical Care Air Transport Teams (CCATT).
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Tracheobronchial injuries (TBI) can be challenging to diagnose, manage, and definitively treat. They encompass a heterogeneous group of injuries that are often associated with other injuries. ⋯ Most TBI can be repaired primarily using a tailored surgical approach and techniques specific to the injury. Associated injuries are common, and surgeons must be knowledgeable in treating a wide variety of physiologic abnormalities, especially those involving the chest wall and lung parenchyma, if a successful outcome is to be achieved in the management of these often challenging patients.