Resuscitative thoracotomy in the emergency department: A case report
Küçük Resim Yok
Tarih
2013
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Resüsitatif Torakotomi (RsT), uygun endikasyon ile hızlı bir şekilde uygulandığında, özellikle toraks ve batın travması olan penetran travmalı hastalarda, hayat kurtarıcı bir girişimdir. Son 30 yılda özellikle gelişmiş ülkelerde olmak üzere tüm dünyada RsT uygulamasına yönelik önemli bir eğilim olmuştur. Yirmi yaşında künt toraks travması olan hasta aniden başlayan göğüs ağrısı ve nefes darlığı şikayeti ile acil servise getirildi. Hastada akciğer yaralanması sonucunda gelişen masif hemopnömotoraks mevcut idi. Hastanın göğüs duvarında görünen bir kanama odağı olmamasına rağmen, hemorajik şok ve bilateral hemopnömotoraks nedeniyle kardiyopulmoner arrest (CPA) gelişti. Hasta entübe edildi ve hemen RsT uygulanmasına başlandı. Pulmoner hilusa el ile acilen baskı uygulanarak hasar kontrolü yapıldı ve akciğerdeki yırtılma cerrahi olarak onarılarak kanama tamamen durduruldu. Hastaya uygulanan açık kalp masajı sonrası hastanın kalp atımı ve nabzı tekrar alınmaya başlandı. Künt toraks travması geçiren hasta, uygulanan RT ve açık kalp masajı ile başarılı bir şekilde resüsite edildi. RsT uygulanan hastaların prognozu; hastanın yaşı, travmanın tipi ve uygulama zamanı olmak üzere bir çok faktöre bağlıdır. Türkiyedeki acil servislerde RsT, nadir uygulanan bir girişimdir. Bu nedenle, sunulan vaka vesilesiyle, RsT nin etkinliği ve endikasyonları tartışıldı. (JAEM 2013; 12: 46-8)
Resuscitative Thoracotomy (RsT) is a lifesaving procedure when performedaccording tor the correct indications and rapid applications in patients sustaining trauma to the thoracoabdominal region, particularly penetrating injuries. In the past three decades, there has been a significant clinical shift in the performance of RsT throughout the world, particularly developed countries. A 20-year-old man with a blunt chest injury presented as an emergency with chest pain and dyspnea, as a result of a massive hemopneumothorax causing lung laceration. He sustained cardiac arrest in the emergency department due to hemorrhagic shock and bilateral hemopneumothorax, despite no apparent thoracic surface injury. He was intubated and RsT was performed immediately. An immediate manual compression of the pulmo- nary hilum was done as damage control, surgical repairm to lung laceration was performed and the bleeding was completely stopped. After open-chest cardiopulmonary rescucitation the patient regained cardiac contraction and pulse. Resuscitation was achieved with RT and internal cardiac massage in the patient who had sustained blunt chest injury. The outcome of the patient to whomRsT is performed is frequently related to multiple factors like age, trauma types and application time. RsT is a rarely performed procedure in an emergency department in Turkey. For this reason, the present case reports discusses the efficiency of RsT and its indications. (JAEM 2013; 12: 46-8)
Resuscitative Thoracotomy (RsT) is a lifesaving procedure when performedaccording tor the correct indications and rapid applications in patients sustaining trauma to the thoracoabdominal region, particularly penetrating injuries. In the past three decades, there has been a significant clinical shift in the performance of RsT throughout the world, particularly developed countries. A 20-year-old man with a blunt chest injury presented as an emergency with chest pain and dyspnea, as a result of a massive hemopneumothorax causing lung laceration. He sustained cardiac arrest in the emergency department due to hemorrhagic shock and bilateral hemopneumothorax, despite no apparent thoracic surface injury. He was intubated and RsT was performed immediately. An immediate manual compression of the pulmo- nary hilum was done as damage control, surgical repairm to lung laceration was performed and the bleeding was completely stopped. After open-chest cardiopulmonary rescucitation the patient regained cardiac contraction and pulse. Resuscitation was achieved with RT and internal cardiac massage in the patient who had sustained blunt chest injury. The outcome of the patient to whomRsT is performed is frequently related to multiple factors like age, trauma types and application time. RsT is a rarely performed procedure in an emergency department in Turkey. For this reason, the present case reports discusses the efficiency of RsT and its indications. (JAEM 2013; 12: 46-8)
Açıklama
Anahtar Kelimeler
Acil Tıp
Kaynak
Akademik Acil Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
12
Sayı
1
