1/2. Blunt chest trauma with deep pulmonary laceration.BACKGROUND: Deep pulmonary laceration (DPL) is rare and its survival rate is low. The present study focused on the prognostic factors of DPL. methods: The present study concerned 17 DPL patients treated in Tokai University Hospital between 1988 and 1998. The prognostic factors of DPL were compared with systolic blood pressure (SBP), PaO2, and the volume of intrathoracic blood loss. Characteristic findings of initial chest roentgenograms of DPL were investigated. RESULTS: Eleven patients were saved and 6 patients died. An SBP of less than 80 mm Hg on arrival at the hospital and a blood loss of more than 1,000 mL through the chest tube within 2 hours after arrival were poor prognostic factors. Hypoxemia on arrival was not a poor prognostic factor. Chest roentgenograms showed macular infiltrative shadow with moderate lung collapse and deviation of the mediastinal shadow toward the unaffected side. Selective bronchial occlusion with a Univent prevented suffocation by intrabronchial blood. CONCLUSIONS: Two poor prognostic factors of DPL are SBP less than 80 mm Hg on arrival and blood loss of more than 1,000 mL through the chest tube within 2 hours after arrival.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/2. Delayed detection of a traumatic diaphragmatic injury caused by positive pressure ventilation: a case report and a proposed system of classification of delayed diagnosis of traumatic injuries.The establishment of regional trauma centers in the united states has resulted in a significant reduction in morbidity and mortality from traumatic injuries. It has also led to a decrease in the incidence of delayed diagnosis of injuries ("missed injuries"), which are not detected during the initial evaluation of these patients. The surgeon managing an acutely injured trauma patient in the initial "golden hour" is faced with leadership, organizational, diagnostic, and therapeutic challenges. The algorithmic approach to the care of the trauma patient has led to the development of protocols to eliminate or at least reduce the incidence of these undetected injuries. The majority of these missed injuries are difficult to reliably detect by conventional diagnostic modalities, are usually asymptomatic, or attention was erroneously diverted to other more overt injuries. We report a case of a patient who sustained a traumatic laceration of his left hemi-diaphragm, which was detected only after positive pressure mechanical ventilation was discontinued. A proposed system of classification of delayed diagnoses is also presented.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |