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Cureus 2020 Dec 4;12(12):e11907. Epub 2020 Dec 4.

Trauma and Acute Care Surgery, Osceola Regional Medical Center, Kissimmee, USA.

This report reviews the indications and complications of resuscitative thoracotomy in the trauma patient as seen with the clinical course of a 19-year-old male who experienced postoperative pericardial tamponade after a bilateral resuscitative thoracotomy with pericardiotomy. This patient presented to the hospital in critical condition with 31 gunshot wounds (GSWs) distributed over the chest, abdomen, and extremities. After undergoing an initially successful resuscitative thoracotomy, the patient continued to bleed into his chest at a greater rate than the chest tubes were able to adequately evacuate. Read More

Pediatr Emerg Care 2021 Jul;37(7):357-359

From the Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan.

Objectives: Acute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH.

Methods: A retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted. Read More

J Thorac Dis 2019 Apr;11(Suppl 6):S913-S920

Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany.

Background: Modern left ventricular assist devices (LVAD) have evolved to become standard of care in severe heart failure (HF) patients. Right HF (RHF) is a major complication responsible for early mortality. Several techniques for temporary right ventricular assist device (t-RVAD) have been described before, baring relevant disadvantages such as limited mobilization or the need for re-thoracotomy. Read More

Anesthesiology 2019 08;131(2):266-278

From the Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Sant'Anna Hospital, Ferrara, Italy (S.S., A.F., F.D.C., N.T., P.M., G.C., V.A., E.D.C., R.R., C.A.V.) the Department of Emergency and Organ Transplant, Aldo Moro University of Bari, Bari, Italy (S.G., T.S.) Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France (M.D.).

Background: Postoperative diaphragmatic dysfunction after thoracic surgery is underestimated due to the lack of reproducible bedside diagnostic methods. We used point of care ultrasound to assess diaphragmatic function bedside in patients undergoing video-assisted thoracoscopic or thoracotomic lung resection. Our main hypothesis was that the thoracoscopic approach may be associated with lower incidence of postoperative diaphragm dysfunction as compared to thoracotomy. Read More

J Emerg Med 2019 Feb 30;56(2):197-200. Epub 2018 Oct 30.

Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.

Background: Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management.

Case Report: An elderly man was brought to the ED having sustained a nail gun injury to the chest. Read More

Trauma Surg Acute Care Open 2018 1;3(1):e000165. Epub 2018 Oct 1.

Department of Surgery, University of Texas Health Science Center at Houston, Memorial Hermann Hospital Red Duke Trauma Institute, Houston, Texas, USA.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become an increasingly popular alternative to emergency thoracotomy and aortic cross-clamping in patients with exsanguinating hemorrhage.1 This new capability is increasingly being used in non-trauma situations.2 3 This report demonstrates another novel use of REBOA for iatrogenic intra-abdominal hemorrhage. Read More

J Med Case Rep 2018 Jul 2;12(1):188. Epub 2018 Jul 2.

Department of Thoracic Cardiovascular Surgery, Chang Gung Memorial Hospital, 123 Avenue Xiafei, Xiamen, 361028, Fujian, China.

Background: Spontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5-11.6% of patients with primary spontaneous pneumothorax. Read More

Turk J Emerg Med 2018 Jun 26;18(2):82-84. Epub 2018 Feb 26.

Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.

A 74-year-old male with chronic kidney disease presented to the emergency department with asystole. Mechanical chest compression was started immediately using a piston-type thumper device. The initial potassium level was 7. Read More

J Trauma Acute Care Surg 2018 07;85(1):78-84

From the Wake Forest Baptist Health (A.N.), Winston-Salem, North Carolina; University of Chicago (P.P.), Chicago, Illinois; University of Southern California (K.I., A.E.), Los Angeles, California; Temple University (Z.M., S.Y.), Philadelphia, Pennsylvania; University of California Los Angeles (D.Y.K., J.M.), Los Angeles, California; University of Maryland (W.C.C., B.D.), Baltimore, Maryland; Cooper University Health Care (J.P.H.), Camden, New Jersey; Loma Linda University (K.M., X.L.-O.), Loma Linda, California; Hennepin County Medical Center (R.M.N., A.P.M.), Minneapolis, Minnesota; Emory University (B.C.M., C.A.F.), Atlanta, Georgia; University of Alabama at Birmingham (P.L.B.), Birmingham, Alabama; Stony Brook University (R.S.J.), Stony Brook, New York; Oregon Health & Science University (S.E.R.), Portland, Oregon; University of Tennessee Health Science Center (L.J.M.), Memphis, Tennessee; Reading Hospital (A.W.O.), Reading, Pennsylvania; Boston Medical Center (T.S.B.), Boston, Massachusetts; Southside Hospital (M.D.G.), Bay Shore, New York; and University of Pennsylvania (M.J.S.), Philadelphia, Pennsylvania.

Background: Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1. Read More

Emerg Med Clin North Am 2018 Feb;36(1):135-147

Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, USA. Electronic address:

Traumatic injuries to the thorax are common after both blunt and penetrating trauma. Emergency medicine physicians must be able to manage the initial resuscitation and diagnostic workup of these patients. This involves familiarity with a range of radiologic investigations and invasive bedside procedures, including resuscitative thoracotomy. Read More

J Trauma Acute Care Surg 2017 12;83(6):1136-1141

From the Division of Trauma and Critical Care, Department of Surgery (N.W.K., T.W.C., D.M.), Medical College of Wisconsin, Milwaukee, WI; and Division of General Surgery, Department of Surgery (J.S.P.), University of New Mexico, Albuquerque, NM.

Background: Thoracic trauma resulting in hemothorax (HTx) is typically managed with thoracostomy tube (TT) placement; however, up to 20% of patients develop retained HTx which may necessitate further intervention for definitive management. Although optimal management of retained HTx has been extensively researched, little is known about prevention of this complication. We hypothesized that thoracic irrigation at the time of TT placement would significantly decrease the rate of retained HTx necessitating secondary intervention. Read More

BMJ Case Rep 2017 Aug 10;2017. Epub 2017 Aug 10.

Department of Pathology, The George Washington University School of Medicine and Health Sciences, Washington, USA.

A 71-year-old man with a history of polycythaemia vera, diagnosed 4 years ago, presented to the emergency room with shortness of breath. A bedside echocardiogram revealed a large pericardial effusion with features concerning for pericardial tamponade. A left anterior thoracotomy and a pericardial window were emergently performed in the operating room and relieved the patient's symptoms. Read More

Int J Surg Case Rep 2016 19;23:98-100. Epub 2016 Apr 19.

Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, NY, United States.

Introduction: Work site injuries involving high projectile tools such as nail guns can lead to catastrophic injuries. Generally, penetrating cardiac injuries are associated with a high mortality rate.

Presentation Of Case: A construction worker was brought to the emergency room having sustained a nail gun injury to the chest. Read More

J Surg Res 2015 Jul 17;197(1):78-84. Epub 2015 Apr 17.

Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona Medical Center, University of Arizona, Tucson, Arizona.

Background: An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a cost-effective Cardiothoracic (CT) Surgery trainer and assessed its potential for improving technical and interprofessional skills during an emergent simulated OT.

Materials And Methods: We modified a commercially available mannequin torso with artificial tissue models to create a custom CT Surgery trainer. Read More

World J Emerg Med 2014 ;5(4):259-63

Department of Accident and Emergency Medicine, Pok Oi Hospital, Au Tau, Yuen Long, Hong Kong, China.

Background: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. Read More

Pak J Med Sci 2013 Jan;29(1):58-63

Bahri Atli, Dept. of Emergency, Karabuk State Hospital, Karabuk, Turkey.

Objective: Thoracic trauma is a common cause of significant morbidity and mortality. This study presents a series of thoracic trauma with the aim to assess epidemiologic features, distribution of pathologies, additional systemic injuries, diagnosis, management and outcome.

Methodology: Between January 2007 and December 2011, all patients with thorax trauma admitted to the emergency service of our hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome. Read More

J Trauma Acute Care Surg 2012 Dec;73(6):1359-63

Department of Surgery, Denver Health Medical Center, Denver, CO, USA.

Background: In the past three decades, there has been a significant clinical shift in the performance of resuscitative thoracotomy (RT), from a nearly obligatory procedure before declaring any trauma patient deceased to a more selective application of RT. We have sought to formulate an evidence-based guideline for the current indications for RT after injury in the patient.

Methods: The Western Trauma Association Critical Decisions Committee queried the literature for studies defining the appropriate role of RT in the trauma patient. Read More

J Emerg Med 2007 Jan;32(1):99-103

R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Ultrasound imaging enhances the physician's ability to evaluate, diagnose, and treat emergency department (ED) patients. Because ultrasound imaging is often time-dependent in the acutely ill or injured patient, the emergency physician is in an ideal position to use this technology. Focused ultrasound examinations provide immediate information and can answer specific questions about the patient's physical condition. Read More

Intensive Care Med 2001 Nov 17;27(11):1756-61. Epub 2001 Oct 17.

Département d'anesthésie-réanimation, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, 47 Boulevard de l'Hôpital, 75651 Paris cedex 13, France.

Objectives: Total body computed tomography (CT) scan is increasingly used in traumatised patients, but the need for an initial rapid imaging assessment beforehand remains unknown. To address this problem, we assessed the value of an initial imaging assessment (chest X-ray, pelvic X-ray, abdominal ultrasonography) in severely traumatised patients in a prospective study.

Design And Setting: Prospective study of a cohort in a level 1 trauma centre of an university teaching hospital. Read More

J Cardiovasc Surg (Torino) 1987 Jan-Feb;28(1):94-7

An unusual case of late partial tamponade of the right atrium is reported in a patient 35 days after aortic valve replacement. Chest x-rays, echocardiograms and ECG were not helpful. The diagnosis was made by emergency bedside right heart catheterization which showed a 7 cm H2O gradient between the junction of the superior vena cava and right atrium and also a 12 cm H2O pressure difference between the femoral vein and the right atrium with a normal capillary wedge pressure. Read More