Search Our Scientific Publications & Authors

CJEM 2020 May 11:1-4. Epub 2020 May 11.

Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, Sudbury, ON.

Introduction: It is traditionally taught that the location to place an ultrasound probe to detect a pneumothorax with point-of-care ultrasound (POCUS) is the anterior chest, given the theory that air will collect at the least dependent area in the supine patient. There is a wide variety of scanning protocols with varying accuracy and completeness. We sought to assess the optimal area to scan for diagnosing pneumothorax by mapping the location of traumatic pneumothorax on computed tomography (CT). Read More

Radiographics 2020 May-Jun;40(3):815-826

From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016.

Direct bicycle handlebar injuries are a significant cause of chest and abdominal trauma and morbidity in the pediatric population. However, these injuries have been underemphasized. While blunt abdominal trauma has been described well, the literature is limited in reviewing trauma imaging specifically related to direct handlebar injuries in the pediatric population. Read More

Neurosurg Rev 2020 Apr 19. Epub 2020 Apr 19.

Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK.

Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Read More

Nagoya J Med Sci 2020 Feb;82(1):59-68

Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Most traumatic pneumothoraxes and hemothoraxes can be managed non-operatively by means of chest tube thoracostomy. This study aimed to investigate how emergency physicians choose chest tube size and whether chest tube size affects patient outcome. We reviewed medical charts of patients who underwent chest tube insertion for chest trauma within 24 hours of admission in this retrospective, single-institution study. Read More

JAMA Netw Open 2020 Mar 2;3(3):e201316. Epub 2020 Mar 2.

Institute for Health Informatics, University of Minnesota Academic Health Center, Minneapolis.

Importance: Rib fractures are sustained by nearly 15% of patients who experience trauma and are associated with significant morbidity and mortality. Evidence-based practice (EBP) rib fracture management guidelines and treatment algorithms have been published. However, few studies have evaluated trauma center adherence to EBP or the clinical outcomes of each practice within a national cohort. Read More

Cureus 2020 Feb 14;12(2):e6996. Epub 2020 Feb 14.

Internal Medicine, Fauji Foundation Hospital, Rawalpindi, PAK.

Cardiac tamponade is a condition characterized by the accumulation of pericardial fluid, compromising the hemodynamics of the circulation. It has several known causes, including traumatic injury to the pericardium, idiopathic, neoplastic or purulent pericarditis, and, rarely, iatrogenic etiology. Inferior vena cava (IVC) filter removal can lead to multiple complications including but not limited to IVC perforation, air embolism, pneumothorax or filter migration. Read More

Expert Rev Respir Med 2020 Jun 15;14(6):587-591. Epub 2020 Mar 15.

Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

: Pneumothorax is defined as the presence of air in the pleural space. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is classified as primary or secondary. There are substantial inconsistencies in international guidelines for the treatment of pneumothorax. Read More

Saudi Med J 2020 Mar;41(3):247-252

King Abdullah International Medical Research Center, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To investigate the incidence and predictors of traumatic pneumothorax using data from a Level-I trauma center in Riyadh, Saudi Arabia.

Methods: This is a retrospective chart-review study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Data were extracted from the hospital's trauma registry (2016-2018). Read More

Zentralbl Chir 2020 Feb 25;145(1):108-120. Epub 2020 Feb 25.

The therapy of severely injured patients is demanding and promising only in an interdisciplinary context. From a thoracic surgical perspective, the blunt chest trauma is in the foreground; as it is the 2nd leading cause of death after traumatic brain injury. The first step is to identify the potentially life-threatening injury and its treatment (airway obstruction, prevention of gas exchange, tension pneumothorax, serious bleeding complications in lung-/vascular injuries). Read More

Ann Thorac Surg 2020 Feb 4. Epub 2020 Feb 4.

Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, Oklahoma.

Background: Cardiac injury is a significant cause of death in patients with traumatic injuries. The Oklahoma Trauma Registry collects data from acute care hospitals in Oklahoma. This study investigated the trends and outcomes of traumatic cardiac injury in Oklahoma over a 10-year period. Read More

AME Case Rep 2019 3;3:46. Epub 2019 Dec 3.

Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

A 21-year-old patient with anorexia developed re-expansion pulmonary edema after delayed drainage of traumatic pneumothorax. The patient was treated with non-invasive respiratory support [helmet continuous positive airway pressure (CPAP) and nasal high flow] until the resolution of the edema. Risk factors associated with re-expansion pulmonary edema are anorexia nervosa, prolonged lung collapse, age in the 20-39 range and re-expansion by high suctioning pressure. Read More

Case Rep Orthop 2020 6;2020:7984936. Epub 2020 Jan 6.

Tanner Clinic, Layton, Utah, USA.

Diagnosing traumatic diaphragmatic rupture (TDR) due to penetrating rib fractures is challenging because the lesions are often too small to be detected and may present years after injury. Patients with delays in diagnosis of TDR rarely present with orthopaedic-related complaints of pain. We report the case of a 52-year-old female who presented with chronic left shoulder pain following a motor vehicle accident (MVA). Read More

Trials 2019 Dec 30;20(1):797. Epub 2019 Dec 30.

Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China.

Background: An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery. This study explored its effect on lung function and pulmonary complication rates in patients with rib fractures. Read More

Respir Physiol Neurobiol 2020 Mar 19;274:103363. Epub 2019 Dec 19.

Emergency Department, C. T. O. Hospital, Naples, Italy.

Background: thoracic trauma is one of the leading causes of death in all age groups and accounts for 25-50 % of all traumatic injuries. With the term lung injury in blunt chest trauma, we identified a spectrum of conditions: lung contusion, pneumothorax and haemothorax. The aim of this study was to evaluate the utility of arterial blood gas analysis parameters in predicting lung injury in blunt chest trauma. Read More

Respir Med Case Rep 2020 18;29:100970. Epub 2019 Nov 18.

Department of Anesthesia & Intensive Care, Command Hospital, Chandimandir, 134107, India.

Intraoperative tracheobronchial injury (TBI) may manifest clinically as pneumothorax, pneumomediastinum, subcutaneous emphysema, cyanosis, and respiratory insufficiency and has serious implications if it remains undetected or is managed improperly. The outcome of such injuries is affected by the extent of the lesion, pulmonary status & the surgical reconstruction undertaken. The recommended airway management of an intraoperative tracheal tear is to bypass the injured side by intubating the healthy bronchus with a single lumen endotracheal tube (ETT) and the use of a bronchial blocker or double lumen endotracheal tube (DLT) and becomes a very challenging situation. Read More

Acad Emerg Med 2020 04 30;27(4):291-296. Epub 2019 Dec 30.

Department of Emergency Medicine, The University of California at San Francisco, San Francisco, CA.

Background: In the era of frequent head-to-pelvis computed tomography (CT) for adult blunt trauma evaluation, we sought to update teachings regarding aortic injury by determining 1) the incidence of aortic injury; 2) the proportion of patients with isolated aortic injury (without other concomitant thoracic injury); 3) the clinical implications of aortic injury (hospital mortality, length of stay [LOS], and rate of surgical interventions); and 4) the screening value of traditional risk factors/markers (such as high-energy mechanism and widened mediastinum on chest x-ray [CXR]) for aortic injury, compared to newer criteria from the recently developed NEXUS Chest CT decision instrument (DI).

Methods: We conducted a preplanned analysis of patients prospectively enrolled in the NEXUS Chest studies at 10 Level I trauma centers with the following inclusion criteria: age > 14 years, blunt trauma within 6 hours of ED presentation, and receiving chest imaging during ED trauma evaluation.

Results: Of 24,010 enrolled subjects, 42 (0. Read More

Asian J Surg 2019 Dec 2. Epub 2019 Dec 2.

Department of General Surgery, 900 Hospital of the Joint logistics Team, Dongfang Hospital, Xiamen University, Fuzhou, Fujian, China. Electronic address:

Background/objective: Thoracic injuries commonly occur after blunt or penetrating trauma, leading to a blowing wound. For thoracic damage control in emergency, we evaluated a novel chest wound treatment device manufactured using expandable material with a one-way valve, and compared it with closed thoracic drainage for first-line treatment of traumatic pneumothorax in a canine model.

Methods: Twenty beagle dogs (10 males and 10 females) were randomly and equally divided into two groups. Read More

Trauma Surg Acute Care Open 2019 4;4(1):e000356. Epub 2019 Nov 4.

Department of Surgery, Broward Health, Fort Lauderdale, Florida, USA.

Background: Thoracic injuries are common in trauma. Approximately one-third will develop a pneumothorax, hemothorax, or hemopneumothorax (HPTX), usually with concomitant rib fractures. Tube thoracostomy (TT) is the standard of care for these conditions, though TTs expose the patient to the risk of infectious complications. Read More

World J Emerg Surg 2019 28;14:52. Epub 2019 Nov 28.

4Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA.

Background: Tractotomy has become the standard of care for transfixing through-and-through lung injuries as it can be performed quickly with little blood loss and a low risk of complications. However, packing with laparotomy pads could be a feasible alternative to tractotomy on selected patients. We describe a series of four patients with lung trauma in which packing of the pulmonary wound tract was used as the primary and unique surgical strategy for arresting hemorrhage from injuries of the lung parenchyma. Read More

Arch Med Sadowej Kryminol 2019 ;69(1-2):56-69

Katedra i Zakład Medycyny Sądowej, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków, Polska/Chair and Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland.

The analysis comprised a total of 450 cases covering the period 2017-2018, in which death was a result of traffic accident, fall from a height, and crushing. Post-mortem examinations carried out at the Department of Forensic Medicine in Krakow consisted of conventional autopsy and post-mortem computed tomography (PMCT). The aims of the study were to evaluate the prevalence of pneumothorax in the study group, and attempt to identify a correlation between pneumothorax and the presence of specific types of thoracic injuries and the circumstances of trauma. Read More

Indian J Otolaryngol Head Neck Surg 2019 Oct 17;71(Suppl 1):693-695. Epub 2018 Sep 17.

Department of ENT, Room No. 441, 4th Floor, College Building, Lokmanya Tilak Municipal Medical College, Sion (West), Mumbai, Maharashtra 400022 India.

Spontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to "Air leak syndrome" following inhalation of foreign body in the airway. Read More

Eur J Emerg Med 2020 Jun;27(3):202-206

Air Ambulance Kent Surrey Sussex (AAKSS), Redhill Airfield.

Objective: Up to 20% of major trauma patients may sustain a pneumothorax. Traumatic pneumothoraces can be difficult to diagnose on scene. Although the use of handheld ultrasound (HHUS) is becoming increasingly widespread, there remains uncertainty about its efficacy as a diagnostic tool in the prehospital setting. Read More

Kyobu Geka 2019 Nov;72(12):1038-1041

Department of Surgery, Chubu Tokusyukai Hospital, Okinawa, Japan.

The 40-year-old male patient was raced to our hospital complaining respiratory difficulty after hitting his left chest at a handle when falling down from a bicycle. Fracture of 5th left rib and partial lung prolapsed intercostally out of the thorax was observed by computed tomography (CT). Due to exacerbated pneumothorax and pneumoderma recognized 12 hours later by CT with the lung remained incarcerated, a surgery was conducted. Read More

JBI Database System Rev Implement Rep 2019 Nov 4. Epub 2019 Nov 4.

Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.

Objective: This systematic review aims to synthesize the available evidence investigating the effectiveness and safety of conservative management of occult pneumothorax in mechanically ventilated patients.

Introduction: Occult pneumothorax is air within the pleural cavity that is diagnosed on a CT scan but was not suspected on the basis of preceding clinical examination or supine chest x-ray. Currently, there is no consensus on how to manage occult pneumothoraces, especially in patients requiring mechanical ventilation. Read More

Turk J Emerg Med 2019 Oct 19;19(4):146-148. Epub 2019 Jul 19.

University of Health Sciences Okmeydanı Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Introduction: We present a rare case of traumatic pneumorrhachis with the combination of hemothorax which resolved rapidly after insertion of a chest tube.

Case Presentation: A 55 year old male was admitted to our emergency department after falling from a ladder. His general condition was well, GCS was 15 with no motor deficits. Read More

Am Surg 2019 Oct;85(10):1134-1138

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. Read More

Eur J Pediatr 2020 Jan 26;179(1):73-79. Epub 2019 Oct 26.

Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, University of Bari "Aldo Moro", Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy.

Pneumothorax in newborns can be life-threatening. The traditional treatment of pneumothorax is chest drain placement. Recently, modified pigtail catheter has been proposed as a less traumatic approach despite limited experience in infants. Read More

Am Surg 2019 Sep;85(9):e465-e467

J Craniofac Surg 2020 Mar/Apr;31(2):e114-e116

Department of Oral & Maxillofacial Surgery at St John's Hospital, Livingston, UK.

Surgical emphysema (SE) is characterized by air in the soft tissues causing a crackling sensation on palpation. In oral and maxillofacial surgery, it might occur using conventional air-driven dental hand pieces, as a complication of trauma and with cocaine insufflation.The subcutaneous air may travel through tissue planes causing cervicofacial emphysema, pneumothorax, and pneumomediastinum. Read More

Front Vet Sci 2019 28;6:291. Epub 2019 Aug 28.

Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.

Pneumothorax is typically ruled out sonographically by detecting a glide sign, lung pulse, and/or B lines, and ruled in by detecting the return of a glide sign and/or presence of a lung point. This case series describes novel lung ultrasound findings (abnormal curtain signs) in dogs with naturally-occurring pneumothorax. This case series also describes a novel lung ultrasound protocol that involves evaluating the curtain sign along the entire thoracoabdominal border and evaluating the ventral pleural space with the probe parallel to the ribs. Read More

Clin Case Rep 2019 Sep 15;7(9):1789-1790. Epub 2019 Jul 15.

First Department of Surgery, Laikon Hospital National and Kapodistrian University of Athens Athens Greece.

A simple case/asymptomatic pneumothorax not deemed to necessitate drainage can quickly change, and patient safety can be compromised. Chest tube insertion with increased suction is considered a safe and efficient strategy in patients with extensive subcutaneous emphysema following traumatic pneumothorax. Read More

Emerg Med Australas 2020 Feb 18;32(1):117-126. Epub 2019 Sep 18.

Trauma Service, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.

Objective: Thoracic trauma is a leading cause of paediatric trauma deaths. Traumatic cardiac arrest, tension pneumothorax and massive haemothorax are life-threatening conditions requiring emergency and definitive pleural decompression. In adults, thoracostomy is increasingly preferred over needle thoracocentesis for emergency pleural decompression. Read More

World J Emerg Surg 2019 2;14:44. Epub 2019 Sep 2.

1Trauma group, Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, P O Box 18532, Al-Ain, United Arab Emirates.

Background: Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. However, the thoracic anatomical locations to be examined are debateable. We aimed to study the anatomical locations of blunt traumatic pneumothoraces as defined by chest CT scan to identify the areas that should be scanned while performing bedside diagnostic ultrasound. Read More

Emerg Radiol 2020 Feb 29;27(1):23-29. Epub 2019 Aug 29.

Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany.

Purpose: Non-traumatic cardiac arrest (CA) and return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) are often associated with multiple pathologies. Expecting a high prevalence of important findings, a whole-body CT (WBCT) could be of relevance for therapy. The aim of this study is to investigate the feasibility and diagnostic yield of an early WBCT in this setting. Read More

Rev Esp Anestesiol Reanim 2019 Oct 26;66(8):434-438. Epub 2019 Aug 26.

Servicio de Anestesiología, Instituto Português de Oncologia do Porto-Francisco Gentil, Porto, Portugal.

Ultrasound has an important role in the diagnosis and prognosis of polytrauma patients. We describe a case of a 52-year-old man with hemodynamic instability and multiple injuries. Abdominal ultrasound evaluation was positive for hemoperitoneum, so an exploratory laparotomy was performed. Read More

BMJ Open 2019 08 8;9(8):e028507. Epub 2019 Aug 8.

Anaesthesia and Critical Care Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Objectives: This feasibility study aimed to assess the acceptability of inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD) who declined pulmonary rehabilitation (PR) as a potential treatment option or precursor to PR. Objectives were to assess attitudes to IMT, PR and alternatives to PR; factors influencing adherence with IMT and acceptability of outcome measures, research tools and study protocol.

Design: A pragmatic, mixed methods, prepost feasibility study was conducted. Read More

Ultrasound J 2019 Apr 25;11(1). Epub 2019 Apr 25.

Emergency & Trauma Department, Hospital Sg Buloh, Sg Buloh, Selangor, Malaysia.

Background: Traumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium. Read More

Int J Crit Illn Inj Sci 2019 Apr-Jun;9(2):75-81

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Purpose: We aimed to assess the pattern and impact of sternal injury with rib fracture in a Level 1 trauma center.

Patients And Methods: We conducted a retrospective review of trauma registry data to identify patients who presented with sternal fracture between 2010 and 2017. Data were analyzed and compared in patients with and without rib fracture. Read More

Trauma Surg Acute Care Open 2019 29;4(1):e000334. Epub 2019 Jun 29.

Department of Surgery, Stanford University, Stanford, California, USA.

Case Presentation: A 38-year-old man was brought in by ambulance as a trauma activation after sustaining a self-inflicted stab wound in the left upper quadrant with a kitchen knife. His primary survey was unremarkable and his vital signs were normal. Secondary survey revealed a 2 cm transverse stab wound inferior and medial to the left nipple. Read More

Int J Surg Case Rep 2019 27;61:30-32. Epub 2019 Jun 27.

Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia. Electronic address:

Introduction: Cardiac tamponade typically results from fluid or gas collection in the pericardial space leading to impairment in the cardiac function.

Presentation Of Case: A 34 years old male patient presented to the ER after a fall from height. X-rays were done which showed no hemothorax or pneumothorax and multiple stable pelvic fractures. Read More

Int J Surg Case Rep 2019 28;60:307-308. Epub 2019 Jun 28.

Unit of Interventional and Diagnostic, Ultrasound of Internal Medicine IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. Electronic address:

Scand J Surg 2019 Jun 23:1457496919857262. Epub 2019 Jun 23.

1 Department of Surgery, University of Turku, Turku, Finland.

Background And Aims: The purpose of this study was to describe the frequency and types of complications after tube thoracostomy among all patients treated with tube thoracostomy for both traumatic and non-traumatic indications.

Material And Methods: Retrospective register-based study of patients treated with tube thoracostomy between the years 2004 and 2014 in a university hospital.

Results: In total, 1808 patients who had undergone tube thoracostomy were identified, complete data on tube thoracostomy treatment was available for 1169 patients. Read More

Clin Med Insights Pediatr 2019 11;13:1179556519855384. Epub 2019 Jun 11.

Neonatal Intensive Care Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.

Pneumothorax is a complication of respiratory distress syndrome, of which many preterm babies suffer. If significant, these pneumothoraces can be treated by the insertion of a chest drain. There are a number of different types of chest drain, and techniques of insertion. Read More

Trop Doct 2019 Oct 18;49(4):311-313. Epub 2019 Jun 18.

Professor and Head, Department of Paediatrics, Smt Kashibai Navale Medical College & General Hospital, Pune, India.

Iatrogenic diaphragmatic hernia is rare in children and we report a preterm low birth weight neonate with a presumably acquired diaphragmatic hernia due to trauma caused by treatment following pneumothorax. Read More

J Thorac Imaging 2019 Jul;34(4):236-247

Departments of Cardiothoracic Surgery.

The diaphragm is an inconspicuous fibromuscular septum, and disorders may result in respiratory impairment and morbidity and mortality when untreated. Radiologists need to accurately diagnose diaphragmatic disorders, understand the surgical approaches to diaphragmatic incisions/repairs, and recognize postoperative changes and complications. Diaphragmatic defects violate the boundary between the chest and abdomen, with the risk of herniation and strangulation of abdominal contents. Read More

J Emerg Trauma Shock 2019 Apr-Jun;12(2):145-149

Department of General Surgery, Lee Kong Chian School of Medicine, Singapore.

Background: Rib fractures are common sequelae after blunt chest wall trauma. They can occur in isolation or association with life-threatening injuries to the head, thorax, and abdomen and may be complicated by hemothorax, pneumothorax, or lung contusions. Contiguous rib fractures can result in flail chest, which is associated with increased morbidity and mortality. Read More

European J Pediatr Surg Rep 2019 Jan 26;7(1):e1-e4. Epub 2019 May 26.

Department of Pediatric Surgery, University Medicine Mainz, Mainz, Germany.

 Isolated tracheobronchial injury after blunt trauma of the chest is rare. Because of the high elasticity of the chest in children, they occur mainly in the pediatric population.  We report a case of a 7-year-old girl who experienced complete avulsion of the right main bronchus at the level of the carina after a horse-riding accident. Read More

Korean J Thorac Cardiovasc Surg 2019 Apr 5;52(2):85-90. Epub 2019 Apr 5.

Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Background: Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention.

Methods: This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Read More

Emerg Med Australas 2019 08 30;31(4):683-687. Epub 2019 Apr 30.

Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.

The intersecting scenarios of multi-trauma, thoracic injury and traumatic cardiac arrest present some of the most demanding moments in paediatric trauma. For these reasons, decision support through teamwork, checklists, technology and guidelines are central to ensuring quality paediatric trauma care. The 'Rule of 4's' is a simple aide-memoire, which guides clinicians of all grades, expertise and distractedness in a reliable approach to injured children who require safe and effective emergency pleural decompression and timely insertion of a chest drain. Read More