1
|
Jakob DA, Müller M, Jud S, Albrecht R, Hautz W, Pietsch U. The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2023; 31:37. [PMID: 37550763 PMCID: PMC10405424 DOI: 10.1186/s13049-023-01107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies. METHODS This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI). RESULTS Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group. CONCLUSION Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.
Collapse
Affiliation(s)
- Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Sebastian Jud
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Roland Albrecht
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Urs Pietsch
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| |
Collapse
|
2
|
Zabani IA, Alhassoun AM, Ahmed HS, Bogis AA, Elmahrouk AF, Jamjoom AA, AlUthman US. Intraoperative spontaneous tension pneumothorax during robotic-assisted coronary artery bypass grafting. J Card Surg 2022; 37:5536-5538. [PMID: 36335593 DOI: 10.1111/jocs.17115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/05/2022] [Accepted: 10/15/2022] [Indexed: 11/08/2022]
Abstract
Patients undergoing robotic-assisted coronary artery bypass grafting are increasing. Several complications have emerged with the increasing use of minimally invasive procedures. We reported a case of spontaneous tension pneumothorax that developed in the ventilated lung during robotic assisted left internal mammary artery harvesting causing severe hemodynamic instability. A sudden rise of airway pressure occurred, and the patient became hypotensive. Immediately, the surgeon was notified to look at the right pleura. Pneumothorax was identified, the right pleura was opened using robotic arms, and the right lung was decompressed. A small emphysematous bulla was identified and stabled. Proper identification of the procedure-associated complications is essential for timely management. Tension pneumothorax is a potentially fatal complication, especially in patients under positive pressure ventilation.
Collapse
Affiliation(s)
- Ibrahim A Zabani
- Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulkarim M Alhassoun
- Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hassan S Ahmed
- Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Farid Elmahrouk
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Faculty of Medicine Tanta University, Tanta, Egypt
| | - Ahmed A Jamjoom
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Uthman S AlUthman
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Okano DR, Chen AW, Mitchell SA, Cartwright JF, Moore C, Boyer TJ. Intraoperative Tension Pneumothorax in a Trauma Patient: An Adult Simulation Case for Anesthesia Residents. Healthcare (Basel) 2022; 10:healthcare10091787. [PMID: 36141399 PMCID: PMC9498657 DOI: 10.3390/healthcare10091787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Anesthesiologists may encounter multiple obstacles in communication when attempting to collect information for emergency surgeries. Occult tension pneumothorax that was asymptomatic in the emergency department (ED) could become apparent upon positive pressure ventilation and pose a critical threat to the patient intraoperatively. Here, we describe a simulation exercise that was developed as a curriculum module for the Indiana University (IU) Anesthesiology residency program. It is primarily designed for first-year clinical anesthesia residents (CA-1/PGY-2). It is a 50 min encounter with two scenarios. The first scenario focuses on information collection and communication with a non-cooperative patient with multiple distractors. The second scenario focuses on the early diagnosis of tension pneumothorax and subsequent treatment. The residents were given formative feedback and met the educational objectives. Commonly missed critical actions included misdiagnosing the tension pneumothorax as mainstem intubation, bronchospasm, pulmonary thromboembolism, and anaphylaxis. Residents rated the feedback and debriefing as “extremely useful” or “very useful.” Time constraints limit the number of residents who can sit in the “hot seat.” The structure of the mannequin limits the ability to diagnose pneumothorax by auscultation and ultrasound. In the future, the scenarios may also be utilized to educate student anesthesiologist assistants and other non-physician anesthesia learners.
Collapse
Affiliation(s)
- David Ryusuke Okano
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Correspondence:
| | - Andy W. Chen
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sally A. Mitchell
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Johnny F. Cartwright
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Christopher Moore
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Tanna J. Boyer
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
4
|
Kang S, Kim Y, Kim DH. A rare complication: Tension pneumothorax after peroral endoscopic myotomy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seokin Kang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Tirimanna R, Myerson J, Okorie M, Dorman E. Diagnosis of spontaneous secondary tension pneumothorax following apparent recovery from coronavirus disease 2019 pneumonitis: a case report. J Med Case Rep 2022; 16:88. [PMID: 35193689 PMCID: PMC8861998 DOI: 10.1186/s13256-022-03313-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 has been associated with a plethora of different manifestations of systems affected (including pulmonary, gastrointestinal, and thrombotic disease) and time to presentation of complications. Pneumothorax has been established as a complication in the literature. However, tension pneumothorax remains a rare presentation with higher mortality. We report a case of secondary tension pneumothorax in a patient following apparent recovery from coronavirus disease 2019 pneumonitis. CASE PRESENTATION Eight days after resolution of coronavirus disease 2019 pneumonitis symptoms, a 51-year-old Caucasian man with no pre-existing pulmonary disease was brought into the emergency department following 48 hours of progressive shortness of breath. Further clinical assessment revealed reduced breath sounds in the right lung, blood pressure was 116/95 mmHg, and jugular venous pressure was not elevated. Chest x-ray showed right-sided tension pneumothorax with mediastinal shift. Insertion of a chest drain led to rapid resolution of symptoms, and the patient was discharged following full re-expansion of the lung. CONCLUSIONS The period of recovery from coronavirus disease 2019 is variable. Clinicians should consider tension pneumothorax as a possible complication of coronavirus disease 2019 pneumonitis in patients presenting with type 1 respiratory failure, even after resolution of pneumonitis symptoms and a considerable time period following initial contraction of coronavirus disease 2019.
Collapse
Affiliation(s)
- Romesh Tirimanna
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - James Myerson
- Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Michael Okorie
- Clinical Pharmacology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Eleanor Dorman
- Barking Havering and Redbridge Hospitals NHS Trust, London, UK
| |
Collapse
|
6
|
Sum R, Lau T, Paul E, Lau K. Gelfoam slurry tract occlusion after computed tomography-guided percutaneous lung biopsy: Does it prevent major pneumothorax? J Med Imaging Radiat Oncol 2021; 65:678-685. [PMID: 34121343 DOI: 10.1111/1754-9485.13256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Computed tomography (CT)-guided lung biopsy is a frequently performed procedure in the diagnostic workup for suspicious lung nodules that can be complicated by pneumothorax. This retrospective study assessed the efficacy of biopsy tract occlusion with a gelatin sponge slurry for preventing post-biopsy pneumothorax. METHODS Retrospective analysis was conducted on consecutive adult patients who underwent CT-guided lung biopsy over a 10-year period. Age, gender, existing chronic obstructive pulmonary disease (COPD), evidence of emphysema on CT, location of the lesion and the presence of pneumothorax on post-procedure CT and 4-h chest radiograph were recorded. RESULTS Two hundred and ninety-six patients were included (126 patients in the non-gelfoam group and 170 in the gelfoam group). When gelfoam was used, risk of developing an immediate pneumothorax was lower (P = 0.032). Patients with emphysema were 2.4 times more likely to develop a delayed pneumothorax without gelfoam (P = 0.034). There was a significantly higher risk of both immediate and delayed pneumothorax in non-peripheral lesions without gelfoam (P = 0.001 and P = 0.002, respectively). The frequency of requiring a chest tube to treat a pneumothorax was 86% lower when gelfoam was used (P = 0.012). CONCLUSION Gelfoam is effective in preventing immediate pneumothorax. In patients with emphysema, there was a significantly higher risk of delayed pneumothorax without gelfoam. Additionally, non-peripheral lesions were more likely to develop pneumothorax when gelfoam was not used. The use of gelfoam was especially important in preventing the development of major pneumothoraces that would require drainage with a chest tube.
Collapse
Affiliation(s)
- Reuben Sum
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Theodore Lau
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kenneth Lau
- Monash Medical Centre, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Open Tension Pneumothorax in "The Dying Niobid" (Uffizi Gallery). Chest 2019; 155:878-880. [PMID: 30955578 DOI: 10.1016/j.chest.2018.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022] Open
|
8
|
Agrawal DR, Nambala SP. A lethal tension pneumothorax during minimally invasive coronary artery bypass surgery: Can transesophageal echocardiography pick it? Ann Card Anaesth 2016; 19:747-749. [PMID: 27716712 PMCID: PMC5070341 DOI: 10.4103/0971-9784.191543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Minimally invasive cardiac surgery is establishing itself as the standard of care across the world. MICS CABG is currently performed in only a few centers. Hemodynamics disturbances are peculiar during MICS CABG due to space constraints. We report a 70-year-old man who underwent MICS CABG who developed tension pneumothorax during revascularization that was diagnosed in a novel way.
Collapse
|
9
|
Cheng CY, Yeh DYW, Lin CL, Kao CH. Risk of Stroke in Patients With Spontaneous Pneumothorax: A Nationwide, Population-Based Study. Medicine (Baltimore) 2016; 95:e3375. [PMID: 27100423 PMCID: PMC4845827 DOI: 10.1097/md.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The association between spontaneous pneumothorax (SP) and stroke has not been reported, and this study aimed to explore this association. We used the National Health Insurance Research Database for conducting a nationwide, population-based, retrospective cohort study of patients newly hospitalized for SP from 2000 to 2010. A total of 2541 patients with newly diagnosed SP were included and compared with patients without SP. We observed that patients with SP were at higher risk for developing stroke, with an adjusted hazard ratio (HR) of 1.56. In addition, these patients had a significantly higher risk of hemorrhagic stroke (adjusted HR = 2.22) than of ischemic stroke (adjusted HR = 1.48). The risk of stroke was the highest in the initial 4 months after hospitalization for SP (adjusted HR = 3.41, 95% confidence interval = 1.98-5.87). In conclusion, our study revealed a correlation between stroke and a history of SP, and the risk of stroke after SP was time sensitive.
Collapse
Affiliation(s)
- Ching-Yuan Cheng
- From the Division of Chest Medicine, Department of Internal Medicine, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei (C-YC, DY-WY); Department of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City (DY-WY); College of Medicine (C-LL) and Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (C-HK), China Medical University; and Management Office for Health Data (C-LL) and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
| | | | | | | |
Collapse
|
10
|
Vallabhajosyula S, Sundaragiri PR, Berim IG. Boerhaave Syndrome Presenting as Tension Pneumothorax: First Reported North American Case. J Intensive Care Med 2015; 31:349-52. [PMID: 26395053 DOI: 10.1177/0885066615606698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/27/2015] [Indexed: 11/16/2022]
Abstract
Tension pneumothorax is a rare and potentially life-threatening clinical complication. A 43-year-old Caucasian woman with type 1 diabetes mellitus presented with nausea and retching and examination revealed dehydration. Laboratory parameters were consistent with a diagnosis of diabetic ketoacidosis, which responded to therapy. Suddenly, 30 hours later, she developed cardiorespiratory compromise due to a tension pneumothorax. After emergent decompression and catheter placement, computerized tomographic scan of the chest demonstrated esophageal-pleural fistula confirming Boerhaave syndrome as the etiology for the pneumothorax. The patient underwent emergent esophagectomy with pleural washout with a subsequent gastric pull-up surgery. Boerhaave syndrome frequently presents atypically with chest pain, dyspnea, and nausea. It communicates with the left pleural space in 80% to 90% of cases, but <5% of cases involve the right pleural cavity. Unexplained and rapidly progressive pleural effusions have been associated with this entity. Only 4 cases of Boerhaave syndrome causing tension pneumothorax have been reported in the literature so far.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ilya G Berim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| |
Collapse
|
11
|
|
12
|
Finite Elements Modeling in Diagnostics of Small Closed Pneumothorax. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 866:7-13. [DOI: 10.1007/5584_2015_150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
13
|
Jain A, Arora D, Juneja R, Mehta Y, Trehan N. Life threatening tension pneumothorax during cardiac surgery. A case report. HEART, LUNG AND VESSELS 2014; 6:204-7. [PMID: 25279363 PMCID: PMC4181282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tension pneumothorax is a life threatening condition that occurs when the intrapleural pressure exceeds atmospheric pressure. It requires prompt diagnosis and immediate treatment. Tension pneumothorax developing postoperatively after cardiac surgery is not uncommon but occurrence in the operating room during cardiac surgery is rare. We report a case of tension pneumothorax intraoperatively during off pump coronary artery bypass grafting.
Collapse
|