Precordial impalement by knife: Extraction under videotoracoscopic vision
It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution&am...
| Autores principales: | , , , , , |
|---|---|
| Formato: | Artículo revista |
| Lenguaje: | Español |
| Publicado: |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2019
|
| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/25812 |
| Aporte de: |
| id |
I10-R327-article-25812 |
|---|---|
| record_format |
ojs |
| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
thoracoabdominal trauma impalement hemothorax thoracoscopy traumatismo toracoabdominal empalamiento hemotorax toracoscopia |
| spellingShingle |
thoracoabdominal trauma impalement hemothorax thoracoscopy traumatismo toracoabdominal empalamiento hemotorax toracoscopia Moretti, GB Muñoz, JA Vélez, SE Suizer, A Sbaffo, JR Brusa, N Precordial impalement by knife: Extraction under videotoracoscopic vision |
| topic_facet |
thoracoabdominal trauma impalement hemothorax thoracoscopy traumatismo toracoabdominal empalamiento hemotorax toracoscopia |
| author |
Moretti, GB Muñoz, JA Vélez, SE Suizer, A Sbaffo, JR Brusa, N |
| author_facet |
Moretti, GB Muñoz, JA Vélez, SE Suizer, A Sbaffo, JR Brusa, N |
| author_sort |
Moretti, GB |
| title |
Precordial impalement by knife: Extraction under videotoracoscopic vision |
| title_short |
Precordial impalement by knife: Extraction under videotoracoscopic vision |
| title_full |
Precordial impalement by knife: Extraction under videotoracoscopic vision |
| title_fullStr |
Precordial impalement by knife: Extraction under videotoracoscopic vision |
| title_full_unstemmed |
Precordial impalement by knife: Extraction under videotoracoscopic vision |
| title_sort |
precordial impalement by knife: extraction under videotoracoscopic vision |
| description |
It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative.
Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in left lung of AP and medial to lateral path, hematoma of the angle, and hemo-pneumothorax grade I.
Surgery: Patient in dorsal recumbency, under ARM with selective intubation. Incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing / aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tube. Evolution: Derived from UTI extubated. CT scan thorax 72 h postqx: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day.
The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2019 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/25812 |
| work_keys_str_mv |
AT morettigb precordialimpalementbyknifeextractionundervideotoracoscopicvision AT munozja precordialimpalementbyknifeextractionundervideotoracoscopicvision AT velezse precordialimpalementbyknifeextractionundervideotoracoscopicvision AT suizera precordialimpalementbyknifeextractionundervideotoracoscopicvision AT sbaffojr precordialimpalementbyknifeextractionundervideotoracoscopicvision AT brusan precordialimpalementbyknifeextractionundervideotoracoscopicvision AT morettigb empalamientoprecordialporarmablancaextraccionbajovisionvideotoracoscopica AT munozja empalamientoprecordialporarmablancaextraccionbajovisionvideotoracoscopica AT velezse empalamientoprecordialporarmablancaextraccionbajovisionvideotoracoscopica AT suizera empalamientoprecordialporarmablancaextraccionbajovisionvideotoracoscopica AT sbaffojr empalamientoprecordialporarmablancaextraccionbajovisionvideotoracoscopica AT brusan empalamientoprecordialporarmablancaextraccionbajovisionvideotoracoscopica |
| first_indexed |
2024-09-03T21:01:05Z |
| last_indexed |
2024-09-03T21:01:05Z |
| _version_ |
1809210163362529280 |
| spelling |
I10-R327-article-258122024-08-27T18:26:20Z Precordial impalement by knife: Extraction under videotoracoscopic vision Empalamiento precordial por arma blanca: Extracción bajo visión videotoracoscópica Moretti, GB Muñoz, JA Vélez, SE Suizer, A Sbaffo, JR Brusa, N thoracoabdominal trauma impalement hemothorax thoracoscopy traumatismo toracoabdominal empalamiento hemotorax toracoscopia It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in left lung of AP and medial to lateral path, hematoma of the angle, and hemo-pneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. Incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing / aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tube. Evolution: Derived from UTI extubated. CT scan thorax 72 h postqx: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy Se encuentra ampliamente establecido que la extracción de objetos empalados debe realizarse bajo visón directa. Ante pacientes estables, se puede utilizar como alternativa la visión endoscópica. Caso Clínico: Masculino de 70 años ingresa por herida de arma blanca precordial empalada de 5 hs. de evolución. Valorado según normas ATLS. Paciente clinica y hemodinámicamente eompensado. Al examen fisico: hipoventilación pulmonar izquierda, enfisema subcutáneo, no ingurgitación yugular. Control de signos vitales: TA: 110/70mmHg, FC: 70min, FR: 20min, Sat02:97%. Estudios complementarios: ECO FAST: no líquido pericárdico. Rx. tórax: hemo neumotórax izquierdo leve. TC tórax: Objeto punzocortante de 18 cm en pulmón izquierdo de trayecto AP y de medial a lateral, hematoma de la língula, y hemo-neumotórax grado I. Cirugía: Paciente en decúbito dorsal, bajo ARM con intubación selectiva. Incisión en 5to espacio intercostal izquierdo, línea axilar media. Colocación de trocar de 10mm, introducción de óptica de 30°. Luego de descartar el compromiso del pericardio, sangrado activo, y observar que el extremo del arma estaba atravesando el extremo de la língula, se extrae el arma bajo visión endoscópica. Lavado/aspiración de coágulos. Constatación de hemostasia, ausencia de fuga aérea y expansión pulmonar. Drenaje con tubo 28 French. Evolución: Se deriva a UTI extubado. TC tórax control 72 hs postqx: pequeño hematoma intraparenquimatoso izq., pulmón expandido. Debito serohemático mínimo. Se extrae tubo pleural y alta definitiva al 4to día postquirúrgico. La bibliografía sugiere en la urgencia, la remoción de objetos empalados bajo visión directa de las estructuras comprometidas. Sin embargo en pacientes estables, debería ser ineludible el estudio previo con TC. La videotoracoscopía en estos heridos, puede evitar una cirugía abierta, pero el procedimiento debe ser realizado en centros de referencia de trauma, con los medios adecuados y por un equipo quirúrgico entrenado dispuesto a realizar una toracotomía de emergencia Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2019-10-17 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/25812 Revista de la Facultad de Ciencias Médicas de Córdoba.; 2019: Suplemento JIC XX Revista de la Facultad de Ciencias Médicas de Córdoba; 2019: Suplemento JIC XX Revista da Faculdade de Ciências Médicas de Córdoba; 2019: Suplemento JIC XX 1853-0605 0014-6722 10.31053/1853.0605.v76.nSuplemento spa https://revistas.unc.edu.ar/index.php/med/article/view/25812/27597 Derechos de autor 2019 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |