Blunt Thoracic Aortic Injuries: An Autopsy Study

Teixeira, Pedro G.R.; Inaba, Kenji; Barmparas, Galinos; Georgiou, Chrysanthos; Toms, Carla; Noguchi, Thomas T.; Rogers, Christopher J.; Sathyavagiswaran, Lakshmanan; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0b013e3181df68b3

Cited by 138 publications

(110 citation statements)

References 13 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…A pedestrian struck by a car was a marginally significant determinant of prehospital mortality (p=0.05). However, the risk of aortic injury is greater in occupants of motor vehicle crashes, which is the leading cause of aortic rupture in our own (49.4%) and other studies with a prevalence between 50% and 57% 3 4 6. We found drivers to be affected threefold as much as non-drivers, but we are not able to compare safety belt users versus non-users, airbag versus non-airbag and side impact versus frontal collision.…”

Section: Discussionsupporting

confidence: 48%

Analysis of risk factors for death after blunt traumatic rupture of the thoracic aorta

Franzen

Genoni

2013

Emerg Med J

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 48%

Analysis of risk factors for death after blunt traumatic rupture of the thoracic aorta

Franzen

Genoni

2013

Emerg Med J

View full text Add to dashboard Cite

show abstract

“…These injuries are responsible for at least one third of the trauma-related fatalities at the scene after motor vehicle and pedestrian auto collisions, and they are likely to be accompanied by various associated thoracic and intraabdominal organ injuries [34]. The isthmusthe junction between the free and fixed portions of the descending aorta just distal to the left subclavian artery-is involved in the majority of cases and results in an 80 % mortality in the first hour following injury.…”

Section: Blunt Thoracic Aortic Injurymentioning

confidence: 99%

Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

View full text Add to dashboard Cite

Injuries to the thorax and the abdomen-the torso-contribute significantly to trauma-related mortality and morbidity. While the vulnerability of the closely organized vital organs to injury in this region plays an important role in morbidity and mortality, the noncompressible nature of hemorrhage in this area also contributes immensely to otherwise preventable trauma deaths. While it is estimated that one fourth of trauma deaths is secondary to chest trauma alone and claims about 16,000 lives per year [1], hemorrhage in the torso (thorax, abdomen, and pelvis) also results in a mortality of as much as 70-80 % after otherwise survivable noncerebral and noncardiac injuries in both civilian and military populations [2]. The overall mortality from exsanguination, which remains second to central nervous system (CNS) injury as a cause of death, primarily originates from injuries of the thorax, abdomen, and pelvis; there has been a reduction in death from extremity bleeding because of effective control with tourniquets or topical hemostatic agents, but not from torso bleeding. With increasing use of anticoagulant agents for prophylaxis and management of cardio-and cerebrovascular disorders, bleedingrelated mortality from truncal injuries is probably more frequent. For example, the predominant injury site in patients with cardiovascular disease who died after trauma in one study was chest in 15 % and abdomen in 3 % of instances; head and neck was the injury site in 69 % of patients [3].In 2008, of the more than 42 million injuryrelated emergency room visits in the United States only 4 % were due to torso injuries; the corresponding percentages for upper extremity injuries, lower extremity injuries, head and neck injuries, and vertebral injuries were 18 %, 15 %, 14 %, and 5 %, respectively [4]. Other diagnoses such as poisoning, adverse effects, ill-defined conditions, and mental disorders made up the remaining injury-related emergency room admissions [4]. Thus, although torso injuries represent a relatively small percentage of the emergency room load, they appear to cause a greater proportion of morbidity and mortality than other injuries.Up to 80 % of thoracic injuries coexist with other injuries in major trauma patients, but they require major surgery and anesthesia relatively infrequently. Yet undetected, relatively minor thoracic injuries may result in life-threatening events during surgery for associated injuries or intensive care management of the multiple trauma patient. Pneumothorax and hemothorax are perfect examples of this clinical situation. On the other hand, because of their sometimes silent nature, even major thoracic injuries (e.g., esophageal, diaphragmatic, and airway trauma) may be missed if appropriate diagnostic

show abstract

“…8,9 About 50% of BCIs occur after motor vehicle crashes; 35% are the result of pedestrians being struck; 9% are secondary to motorcycle crashes; and the balance are mostly attributable to falls from significant heights. 3,8 Although less frequent than blunt aortic injuries, nonpenetrating injuries to the heart (ie, BCIs) are often lethal if the injuries include structural damage to a cardiac chamber. However, as our case demonstrates, a BCI must not always come as a death knell.…”

Section: Discussionmentioning

confidence: 99%

Common Cause of Mortality in Trauma but Manageable Nonetheless

et al. 2015

View full text Add to dashboard Cite

Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Eachempati and Salemi), who respond to the information, sharing their reasoning with the reader (regular type). A discussion by the authors follows.A n obese but otherwise healthy 53-year-old man was unloading a delivery van when he was struck from behind by a slow-moving garbage truck, pinning him between the 2 vehicles. The patient was lying supine on the ground when emergency medical services arrived. He was alert and oriented with a Glasgow Coma Scale score of 15. The patient was complaining of pain in his right upper extremity and numbness in his left foot. His initial vital signs were notable for a heart rate of 100 bpm; his blood pressure was 150/90 mm Hg; and his breathing was elevated at 22 breaths per minutes. The patient denied loss of consciousness and had no neck, back, or chest pain. Per emergency medical services, the patient's midchest appeared erythematous and his left lung field was coarse on auscultation, and he had a small abrasion on his left knee. The rest of his in-the-field examination was unremarkable. A cervical collar was placed, and the patient was placed on a back-board for transport. The patient's vital signs remained stable en route per the emergency medical services' report, although he became increasingly anxious and repeatedly removed both his cervical collar and a nonrebreather mask that had been placed empirically.On arrival in our trauma bay, the patient was found to be in shock: pulse rate, 129 bpm; blood pressure, 69/51 mm Hg; respiratory rate, 20 breaths per minute; and O 2 saturation, 80% on room air. He remained awake with a Glasgow Coma Scale score of 15 but now was complaining of difficulty breathing and of right-sided chest and back pain. His primary survey was notable for rhonchorous breath sounds bilaterally and right-sided chest wall crepitus; his abdomen was soft and had no peritoneal signs. The patient remained tachycardic, but his blood pressure improved to 127/113 mm Hg as 2 L crystalloid and 1 U red blood cells were given in bolus. His O 2 saturation improved to 96% on a nonrebreather mask providing O 2 at 15 L/min. His initial ECG demonstrated sinus tachycardia with questionable electric alternans in leads V 1 and V 5 (Figure 1). The patient's focused assessment with sonography for trauma (FAST) examination was unremarkable. A chest radiograph revealed extensive right subcutaneous emphysema, multiple right lateral rib fractures, a small rightsided apical pneumothorax, and bilateral patchy opacities consistent with pulmonary contusion or hemorrhage. His cardiomediastinal silhouette was normal (Figure 2A). A pelvic radiograph was negative for injury. A right chest tube was inserted with minimal serosanguinous output ( Figure 2B), and a Foley catheter was placed.Dr Eachempati: Care of traumatically injured patients demands the participation of various members of a large, interdisciplinary team and, depending on local practice, can involve surgeons, emergenc...

show abstract

Blunt Thoracic Aortic Injuries: An Autopsy Study

Abstract: Thoracic aortic injuries occurred in fully one third of blunt traumatic fatalities, with the majority of deaths occurring at the scene. The risk for associated thoracic and intra-abdominal injuries is significantly increased in patients with thoracic aortic injuries.

Cited by 138 publications

References 13 publications

Analysis of risk factors for death after blunt traumatic rupture of the thoracic aorta

Analysis of risk factors for death after blunt traumatic rupture of the thoracic aorta

Thoracic and Abdominal Injuries

Common Cause of Mortality in Trauma but Manageable Nonetheless

Contact Info

Product

Resources

About