Seminars in thoracic and cardiovascular surgery
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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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Trauma remains the leading cause of death for children aged 1 to 14 years. Thoracic trauma is seen in 4% to 6% of pediatric patients presenting to pediatric trauma centers and rarely occurs in isolation. The medical and surgical evaluation of children is a challenging task to even the most experienced physician. ⋯ While noting children are not small adults, the systematic approach taken towards the evaluation of an adult is similar. Sequential evaluation and management of the ABCs by a caregiver familiar with age specific norms is the most important initial consideration. The care of specific injuries is similar to those found in adults but the patient's size limits the physician's options in many cases.
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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.