scholarly journals Predictors of survival after emergency department thoracotomy in trauma patients with predominant thoracic injuries in Southern Israel: a retrospective survey

2019 ◽  
Vol Volume 11 ◽  
pp. 95-101
Author(s):  
Yael Refaely ◽  
Leonid Koyfman ◽  
Michael Friger ◽  
Leonid Ruderman ◽  
Mahmoud Abu Saleh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patients ◽  
Thoracic Injuries ◽  
Retrospective Survey ◽  
Emergency Department Thoracotomy

Extreme Interventions for Trauma Patients in Extremis: Variations among Trauma Centers

2017 ◽  
Vol 83 (10) ◽  
pp. 1033-1039
Author(s):  
Galinos Barmparas ◽  
Ara Ko ◽  
Navpreet K. Dhillon ◽  
James M. Tatum ◽  
Mark Choi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
National Level ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Inclusion Criteria ◽  
Emergency Department Thoracotomy ◽  
National Trauma ◽  
High Level ◽  
Trauma Surgeons

Although guidelines for the performance of an emergency department thoracotomy (EDT) are available, high level evidence remains scarce potentially leading to variation in decisions and practices among trauma surgeons. The National Trauma Databank was queried for all subjects who died in the emergency department (ED) between 2007 and 2011. Trauma centers were divided into four quartiles based on the rate of EDTamong ED deaths. A total of 31,623 subjects admitted to 729 trauma centers met inclusion criteria. Most of of these centers (n = 328, 53%) never performed an EDT during the study period. Very few outlier centers (1.1%) performed this procedure in 50.0 per cent or more of all patients who died in the ED. Trauma centers in the highest quartiles in performing EDT were more likely to intervene with both surgical and nonsurgical procedures in patients who died in the ED, independent of the performance of an EDT. There are significant variations among trauma centers in the management of trauma patients who expire in the ED. Further research at a national level toward standardizing the management of the trauma patient in extremis and the decision to perform an EDT is necessary, given the extremely low survival associated with this procedure.

scholarly journals Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Julian J Owen ◽  
Niv Sne ◽  
Angela Coates ◽  
Peter K Channan
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Trauma Patients ◽  
National Guidelines ◽  
Emergency Department Thoracotomy ◽  
Life Saving ◽  
Record Review

AbstractObjectiveEmergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines.MethodsRetrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge.ResultsOver a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines.ConclusionsSurvival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications.

Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Noncompressible Torso Hemorrhage

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Derek Jason Roberts ◽  
Bryan A. Cotton ◽  
Juan Duchesne ◽  
Paula Ferrada ◽  
Tal M. Horer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Circulatory Arrest ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Trauma Patients ◽  
Post Injury ◽  
Emergency Department Thoracotomy ◽  
Advantages And Disadvantages ◽  
Injured Patients ◽  
Endovascular Balloon Occlusion

Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

scholarly journals Multidisciplinary Approach for the Management of Complex Hepatic Injuries AAST-OIS Grades IV—V: A Prospective Study

2007 ◽  
Vol 96 (3) ◽  
pp. 214-220 ◽  
Author(s):  
J. A. Asensio ◽  
P. Petrone ◽  
L. Garcí-Núñez ◽  
B. Kimbrell ◽  
E. Kuncir
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Loss ◽  
Blood Cells ◽  
Multidisciplinary Approach ◽  
Stepwise Logistic Regression ◽  
Packed Red Blood Cells ◽  
Emergency Department Thoracotomy ◽  
Estimated Blood Loss ◽  
Hepatic Injuries

Background: Complex hepatic injuries grades IV—V are highly lethal. The objective of this study is to assess the multidisciplinary approach for their management and to evaluate if survival could be improved with this approach. Study Design: Prospective 54-month study of all patients sustaining hepatic injuries grades IV—V managed operatively at a Level I Trauma Center. Main outcome measure: survival. Statistical analysis: univariate and stepwise logistic regression. Results: Seventy-five patients sustained penetrating (47/63%) and blunt (28/37%) injuries. Seven (9%) patients underwent emergency department thoracotomy with a mortality of 100%. Out of the 75 patients, 52 (69%) sustained grade IV, and 23 (31%) grade V. The estimated blood loss was 3,539±-3,040 ml. The overall survival was 69%, adjusted survival excluding patients requiring emergency department thoracotomy was 76%. Survival stratified to injury grade: grade IV 42/52–81%, grade V 10/23–43%. Mortality grade IV versus V injuries (p <0.002; RR 2.94; 95% CI 1.52–5.70). Risk factors for mortality: packed red blood cells transfused in operating room (p=0.024), estimated blood loss (p<0.001), dysryhthmia (p<0.0001), acidosis (p=0.051), hypothermia (p=0.04). The benefit of angiography and angioembolization indicated: 12% mortality (2/17) among those that received it versus a 36% mortality (21/58) among those that did not (p=0.074; RR 0.32; 95% CI 0.08–1.25). Stepwise logistic regression identified as significant independent predictors of outcome: estimated blood loss (p=0.0017; RR 1.24; 95% CI 1.08–1.41) and number of packed red blood cells transfused in the operating room (p=0.0358; RR 1.16; 95% CI 1.01–1.34). Conclusions: The multidisciplinary approach to the management of these severe grades of injuries appears to improve survival in these highly lethal injuries. A prospective multi-institutional study is needed to validate this approach.

Emergency department thoracotomy

1982 ◽  
Vol 11 (8) ◽  
pp. 413-416 ◽  
Author(s):  
Timothy C. Flynn ◽  
Richard E. Ward ◽  
Priscilla W. Miller
Keyword(s):  
Emergency Department ◽  
Emergency Department Thoracotomy
Sign in / Sign up

Export Citation Format

Share Document