Guidelines for the Diagnosis and Treatment of Thoracic Traumatism

Gilart, Jorge Freixinet; Rodríguez, Helena Hernández; Vallina, Primitivo Martínez; Balsalobre, Ramón Moreno; Suárez, Pedro Rodríguez

doi:10.1016/s1579-2129(11)70007-6

Cited by 11 publications

(12 citation statements)

References 47 publications

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“…noted that pain relief in multiple rib fractures patients is transcendental, as it allows for proper ventilation, effective cough, and adequate respiratory physiotherapy. [ 10 ] They observed that intravenous use of nonsteroidal and nonopiate anti-inflammatory drugs is quite widespread, although their side effects are their main drawback. [ 10 ] He therefore concluded that locoregional techniques which include ICNB and epidural analgesics are some available options.…”

Section: Discussionmentioning

confidence: 99%

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Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures

Ekpe

Eyo

2017

Ann Afr Med

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Background:Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study.Methods:This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury.Results:There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as “okada”) and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates >30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2 of 96%. This improved after 1 h of administration of analgesics to SpO2 of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2 of < 97% (P = 0.006). Before analgesia, no patient was able to achieve peak expiratory flow rate (PEFR) value >100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%–100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values >100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%–100% predicted.Conclusion:Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through improvement in respiratory mechanics.

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Section: Discussionmentioning

confidence: 99%

“…[ 10 ] They observed that intravenous use of nonsteroidal and nonopiate anti-inflammatory drugs is quite widespread, although their side effects are their main drawback. [ 10 ] He therefore concluded that locoregional techniques which include ICNB and epidural analgesics are some available options. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures

Ekpe

Eyo

2017

Ann Afr Med

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“…La TAC es complementaria a la radiografía de tórax. La solicitud oportuna de la TAC en el abordaje del paciente con trauma moderado o grave conlleva un incremento en el diagnóstico de hemotórax oculto; sin embargo, el análisis de costo-beneficio y el impacto clínico deberá aclararse en ensayos clínicos subsecuentes (9).…”

Section: Diagnósticounclassified

“…Después de colocar la sonda endopleural, se sugiere realizar una radiografía simple con el objetivo de identificar la posición del tubo torácico (específicamente para ratificar la colocación dentro del espacio pleural) (21); asimismo, poder identificar anormalidades intratorácicas previamente no visualizadas por el hemotórax (3,9).…”

Section: Diagnósticounclassified

“…En casos con hemotórax, pueden ser utilizados para mejorar el drenaje cuando se documenta la fase de coagulación, pero la evidencia es limitada; los estudios disponibles se han realizado del 1º al 30º días después de la colocación de drenaje pleural con resultados satisfactorios (23); sin embargo, otros autores los recomiendan en el periodo subagudo (durante los primeros 6 a 13 días de evolución); la evidencia es controversial, dado que, los resultados provienen de series de casos pequeñas que carecen de controles y han mostrado dificultades para medir la mejoría del hemotórax con la intervención propuesta (23,24). Por ello, se les considera como tratamiento de segunda línea con enfoque en pacientes que tienen riesgos significativos de someterse a un procedimiento quirúrgico (9,23).…”

Section: Diagnósticounclassified

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Hemotórax: etiología, diagnóstico, tratamiento y complicaciones

2016

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La sospecha de hemotórax inicia con una historia clínica adecuada, particularmente, el padecimiento actual, por ejemplo, casos con trauma torácico. El paso inicial de la evaluación, es diferenciar los derrames pleurales hemorrágicos de los verdaderos hemotórax. Confirmar el diagnóstico de manera temprana es fundamental, dado que, conforme progresan las fases de organización del coágulo, se van desarrollando adherencas entre la superficie del parénquima pulmonar y la pleura parietal, aspecto que dificulta evacuarlo mediante drenaje pleural convencional. La radiografía de tórax continúa siendo el estudio complementario inicial, sin embargo, es importante realizar estudios adicionales que permitan orientar la decisión terapéutica; la elección del análisis paraclínico puede justificarse con base en la experiencia y disponibilidad de recursos en el centro de atención. La instalación del tratamiento primario es crucial e inicia con el drenaje de la cavidad torácica vía sonda pleural en la mayoria de los casos; el uso de fibrinoliticos se considera de segunda línea y particularmente en hemotórax coagulado o casos que tienen riesgos significativos de complicaciones al someterse a un procedimiento quirúrgico mayor (Por ejemplo. decorticación). Las complicaciones se pueden disminuir al sistematizar el enfoque diagnóstico-terapéutico.Palabras clave: hemotórax, hemotórax coagulado, toracoscopía video-asistida, tratamiento, sonda pleural, trauma de tórax.

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