Surgery & Traumatology
Traumatic thoracic & abdominal injuries
Traumatic thoracic injuries require specialized management to prevent respiratory compromise and other complications. Hemothorax and pneumothorax management involves diagnostic imaging, tube thoracostomy, and surgical interventions as needed. Pulmonary contusion and flail chest necessitate early respiratory support, effective pain management, and selective surgical stabilization to improve outcomes. Blunt cardiac injury requires prompt diagnosis using ECG and imaging, with tailored treatment for arrhythmias and hemodynamic instability.
Traumatic abdominal injuries also demand tailored management strategies. Splenic trauma management prioritizes non-operative strategies, including observation and angioembolization, with surgery reserved for severe cases. Liver trauma management similarly emphasizes non-operative management when feasible, using surgery for high-grade injuries to optimize patient outcomes. Both splenic and liver trauma guidelines highlight the importance of preserving organ function and preventing complications, with special considerations for pediatric patients.
Traumatic thoracic injuries
Hemothorax
Hemothorax and pneumothorax
Practice Management Guidelines for Management of Hemothorax and Occult Pneumothorax
Nathan T. Mowery et al., Journal of Trauma: Injury, Infection & Critical Care (2011)
What’s inside
This article provides practice management guidelines for the treatment of hemothorax and occult pneumothorax, focusing on evidence-based recommendations for trauma patients.
Why it’s relevant
Hemothorax and occult pneumothorax are common complications in trauma patients, requiring timely and effective management to prevent respiratory compromise and other complications.
Key focus
- Diagnostic approaches, including imaging (e.g., chest X-ray, CT)
- Indications for tube thoracostomy and surgical intervention
- Management strategies for retained hemothorax
- Considerations for observation versus intervention in occult pneumothorax
Takeaway
The guidelines emphasize a tailored approach to managing hemothorax and occult pneumothorax, balancing the risks and benefits of intervention to optimize patient outcomes.
Pulmonary contusion and flail chest
Pulmonary contusion and flail chest
Management of pulmonary contusion and flail chest
Bruce Simon et al., Journal of Trauma and Acute Care Surgery (2012)
What’s inside
This article reviews the management of pulmonary contusion and flail chest, focusing on evidence-based strategies to optimize outcomes in trauma patients.
Why it’s relevant
Pulmonary contusion and flail chest are common in blunt chest trauma and can lead to significant respiratory complications, requiring specialized care.
Key focus
- Pathophysiology and clinical presentation of pulmonary contusion and flail chest
- Ventilatory strategies, including non-invasive and invasive ventilation
- Pain management and regional anesthesia techniques
- Surgical stabilization for flail chest
Takeaway
The article highlights the importance of early respiratory support, effective pain management, and selective surgical intervention to improve outcomes in patients with pulmonary contusion and flail chest.
Blunt cardiac injury / cardiac contusion
Blunt cardiac injury
Managing blunt cardiac injury
Lawrence Nair et al., Journal of Cardiothoracic (2023)
What’s inside
This article provides a comprehensive review of the diagnosis and management of blunt cardiac injury (BCI), focusing on evidence-based strategies for trauma patients.
Why it’s relevant
BCI is a potentially life-threatening condition that requires prompt recognition and appropriate management to prevent complications and improve outcomes.
Key focus
- Diagnostic tools, including ECG, troponin levels, and imaging (e.g., echocardiography)
- Management strategies for arrhythmias and hemodynamic instability
- Indications for surgical intervention in severe cases
- Long-term monitoring and follow-up for complications
Takeaway
The article emphasizes the importance of early diagnosis, tailored treatment, and close monitoring to effectively manage blunt cardiac injury and reduce morbidity and mortality.
Traumatic abdominal injuries
Splenic trauma
Splenic trauma
Splenic trauma: WSES classification and guidelines for adult and pediatric patients
Federico Coccolini et al., World Journal of Emergency Surgery (2017)
What’s inside
This article presents the WSES classification and guidelines for the management of splenic trauma in both adult and pediatric patients, focusing on evidence-based recommendations.
Why it’s relevant
Splenic trauma is a common injury in blunt abdominal trauma, and its management requires a tailored approach to preserve splenic function and prevent complications.
Key focus
- WSES classification system for splenic trauma severity
- Non-operative management (NOM) strategies, including observation and angioembolization
- Indications for surgical intervention
- Special considerations for pediatric patients
Takeaway
The guidelines emphasize a patient-centered approach, prioritizing non-operative management when feasible and reserving surgery for severe cases to improve outcomes in splenic trauma patients.
Liver trauma
Liver trauma
Liver trauma: WSES 2020 guidelines
Federico Coccolini et al., World Journal of Emergency Surgery (2020)
What’s inside
This article provides the 2020 WSES guidelines for the management of liver trauma, offering evidence-based recommendations for both adult and pediatric patients.
Why it’s relevant
Liver trauma is a significant cause of morbidity and mortality in abdominal injuries, requiring timely and effective management to optimize outcomes.
Key focus
- Classification of liver trauma severity
- Non-operative management (NOM) strategies, including observation and angioembolization
- Indications for surgical intervention and damage control surgery
- Special considerations for high-grade injuries and pediatric patients
Takeaway
The guidelines advocate for a tailored approach, prioritizing non-operative management when appropriate and using surgery for severe cases to improve survival and reduce complications in liver trauma patients.