A life-saving approach after thoracic trauma: Emergency room thoracotomy

BACKGROUND
In this article, the outcomes, indications and methods of emergency department service resuscitative thoracotomy in cardiac and/or respiratory arrest patients after thoracic trauma are discussed.
METHODS
Between January 2004 and December 2010, nine resuscitative thoracotomies were performed after thoracic trauma in the emergency department of our hospital. The records of the patients were evaluated retrospectively.
RESULTS
A total of nine patients underwent resuscitative thoracotomy: five stab wounds, two traffic accidents, one fall from height, and one gunshot wound. Anterolateral thoracotomy in supine position was performed in all. Three patients had lung parenchymal laceration, three patients had cardiac laceration, two patients had intercostal vessel injury, and one patient had descending aorta injury. None of the four patients with blunt trauma recovered. Three of five patients with penetrating trauma were discharged after an average of eight days of follow-up, whereas two of them were lost perioperatively.
CONCLUSION
Emergency room thoracotomy can be performed in thoracic trauma cases who are in shock and have unresponsive hypotension despite large volume fluid and blood replacement and no time for transportation to the operating room. The results are better in penetrating trauma patients than in blunt trauma.

Toraks travmasý sonrasý hayat kurtarýcý bir uygulama: Acil serviste torakotomi

AMAÇ
Bu çalýþmada, toraks travmasý sonrasý hastanemiz acil servisine (AS) getirilen ve yapýlan giriþim sýrasýnda kalp ve/veya solunumu duran hastalarda, acil serviste uygulanan resüsitatif torakotominin endikasyonlarý, yöntemi ve sonuçlarý tartýþýldý.
GEREÇ VE YÖNTEM
Ocak 2004 ile Aralýk 2010 tarihleri arasýnda toraks travmasý sonrasý AS’de dokuz hastaya resüsitatif torakotomi uygulandý. Hasta verileri geriye dönük olarak incelendi.
BULGULAR
Dokuz hastaya AS koþullarýnda giriþim yapýldý; beþi kesici delici alet yaralanmasý, ikisi trafik kazasý, birer hasta yüksekten düþme ve ateþli silah yaralanmasý nedenliydi. Tüm hastalara sýrtüstü pozisyonda anterolateral torakotomi uygulandý. Üç hastada akciðer parankimal laserasyonu, üç hastada kardiyak laserasyon, diðer iki hastada interkostal damarlar yaralanmasý ve bir hastada ise inen aortada laserasyon vardý. Etyolojisinde künt travma olan dört hasta kaybedildi, penetran travma nedeniyle resüsitatif torakotomi uygulanan beþ hastanýn üçü ortalama sekiz gün izlem sonrasýnda þifa ile taburcu edildi, diðer ikisi ameliyatta kaybedildi.
SONUÇ
AS koþullarýnda resüsitatif torakotomi uygulanan hastalar, travma sonrasý þok halindedir, büyük oranda sývý ve kan infüzyonu yapýlmasýna karþýn hipotansiyonu kontrol altýna alýnamayan ve ameliyat salonuna nakil için vakit kaybýna tahammülü olmayan hastalardýr. Penetran travmalý hastalarýn sonuçlarý künt toraks travmalý hastalara göre daha iyidir.