Canadian journal of surgery. Journal canadien de chirurgie
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Many pitfalls exist in treating patients with blunt and penetrating wounds of the chest and abdomen. The thoracic and abdominal cavities should not be dissociated in the examiner's mind because apparently trivial lesions of one may be associated with serious lesions of the other. Constellations of injuries should be sought, especially in blunt and seat-belt injuries. ⋯ When splenectomy is unavoidable, decisions about the need for penicillin and pneumococcal vaccine are important and should include dose and frequency. Liver injuries are also treated more conservatively. Lobectomy is seldom necessary as assiduous local hemostasis and débridement (accompanied in about 3% of cases by ligation of the hepatic artery) are effective when good exposure and preliminary measures to achieve temporary hemostasis are obtained.
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Blunt chest trauma continues to be an important cause of death following motor vehicle accidents in Canada. Current methods of diagnosis are presented emphasizing a physiologic approach. The most important physiologic consequence of trauma associated with chest wall instability or ruptured diaphragm is pulmonary contusion. ⋯ Methods for recognizing and treating cardiac tamponade are outlined. The indications for early thoracotomy following cardiac trauma are listed; thoracotomy should be done in a fully equipped operating room rather than the emergency room. Successful management of major chest injuries requires an aggressive physiologic approach to diagnosis and emphasis on maintaining effective ventilation and adequate cardiac output.