Advances in the diagnosis and treatment of thoracic trauma.
With the exception of the use of ECG to screen patients for blunt cardiac injury, recent advances in the diagnosis of thoracic trauma involve new technology. Use of surgeon-performed pericardial and pleural ultrasound for the detection of tamponade or hemothorax, TEE or spiral CT to diagnose rupture of the thoracic aorta, and thoracoscopy to evaluate a hemothorax or the integrity of the left hemidiaphragm are all standard techniques in modern trauma centers. In terms of treatment, emergency center thoracotomy is performed more selectively and with the adjunct of staple closure for cardiac wounds. Pulmonotomy is used selectively to control deep lobar hemorrhage and to avoid the need for an emergent lobectomy. Finally, nonoperative management of an intimal tear of the thoracic aorta or delayed operative management of a full-thickness tear in the patient with multiple injuries, using beta-blocker-induced relative hypotension, is rapidly becoming the standard of care throughout the United States.
Feliciano
D V
DV
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Rozycki
G S
GS
D000784:Aortic Dissection / Q000601:surgery / Q000628:therapy; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis; D001019:Aortic Rupture / Q000175:diagnosis; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D006335:Heart Injuries / Q000175:diagnosis; D006470:Hemorrhage / Q000601:surgery; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D011013:Pneumonectomy; D017792:Surgical Stapling; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis