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19 results on '"Traumatismo torácico"'

1. Intervenções de enfermagem à pessoa em situação crítica com traumatismo torácico: scoping review.

Author

Marta Yarynych, Sónia Bastos, and Susana Miguel

Subjects
Cuidados de enfermagem, Traumatismo torácico, Doente Crítico, Unidade de Cuidados Intensivos, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Introdução: O trauma torácico tem sido descrito como uma das principais causas de morte e a sua incidência tem vindo a aumentar a nível mundial nos últimos anos. Uma rápida e correta intervenção e vigilância adequada do enfermeiro tem um efeito determinante na redução da morbilidade e mortalidade da pessoa com traumatismo torácico. Objetivos: Mapear o conhecimento de forma a identificar as intervenções de enfermagem à pessoa em situação crítica com traumatismo torácico. Materiais e métodos: Foi realizada síntese de evidência através de uma Scoping Review, seguindo a metodologia do Joanna Briggs Institute. Pesquisa realizada em cinco bases de dados: PubMed, Scopus, MEDLINE Complete, CINAHL Complete e Cochrane Library. Os dados foram extraídos para uma tabela de extração de dados previamente construída. Resultados: De um total de 4701 registos identificados, após aplicação de critérios de inclusão e exclusão, foram analisados sete estudos. As intervenções de enfermagem foram identificadas e organizadas numa tabela de extração de dados. Conclusões: Foram identificadas intervenções de enfermagem autónomas e interdependentes, dada a sua especificidade e complexidade, foram agrupadas, para os diferentes tipos de traumatismo torácico. As intervenções mais frequentes correspondem à gestão da dor, gestão da oxigenoterapia, colaboração na colocação de drenos torácicos e vigilância dos mesmos, administração de hemoderivados e avaliação e vigilância hemodinâmica e sinais de dificuldade respiratória. No entanto, considera-se fundamental a realização de mais estudos científicos que forneçam uma base sólida e atualizada para os cuidados de enfermagem, para comprovarem os ganhos em saúde.

Published
2024
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2. Traumatismo torácico con lesión de grandes vasos del tórax: características, tratamiento y variables asociadas a mortalidad.

Author

L., Roberto González, Alarcón O., Felipe, Riquelme U., Alejandra, M., Rodrigo Reyes, Bravo S., Juan C., and Alarcón C., Emilio

Abstract

Background: Thoracic great vessel injuries in thoracic trauma (TTGVI) are a heterogeneous group of injuries with high morbimortality that constituting 0.3-10% of the findings in thoracic trauma (TT). Aim: To describe characteristics, treatments and variables associated with mortality in hospitalized patients with TTGVI. Methods: Observational-analytical study. Period January-1981 and December-2020. Review of prospective TT protocols and clinical records. TTGVI were classified according to American Association for the Surgery of Trauma (AAST), trauma severity index were calculated: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) and Trauma Injury Severity Score (TRISS). Univariate and multivariate analysis was performed with calculation of Odds Ratio (OR) for variables associated with mortality. SPSS25® was used, with U Mann Whitney and chi-squared tests, as appropriate. Results: From a total of 4.577 TT in the period, 97 (2.1%) met the inclusion criteria. Males: 81 (91.8%), mean age: 32.3 ± 14.8 years. Penetrating TT: 65 (67.0%). Axillary-subclavian artery lesions in 39 (40.2%) and thoracic aorta in 31 (32.0%) were more frequent. AAST 5-6: 39 (40.2%). Invasive treatment: 87 (89.7%), of these, in 20 (20.6%) endovascular repair, 14 (14.4%) of thoracic aorta. Open surgery in 67 (69.1%). Mortality in 13 (13.4%), shock on admission was independently associated with mortality (OR 6.34) and ISS = 25 (OR 6.03). Conclusion: In our series, TTGVI were more frequent in axillary-subclavian vessels and thoracic aorta. Treatment was mainly invasive, with open surgery being the most frequent. Variables associated with mortality were identified. [ABSTRACT FROM AUTHOR]

Published
2022
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3. Traumatismo toracoabdominal cerrado

Author

Julio Mañana

Subjects
traumatismo tóracico, cirugía torácica, hernia, Surgery, RD1-811
Abstract

Presentado en sesión de 13 de setiembre de 1961

Published
2020

4. Fístula gastropleural por trauma toracoabdominal por proyectil de arma de fuego, reporte de caso

Author

Gabriela Tula Cotera Abad

Subjects
Traumatismo torácico, Fístula gastropleural, Drenaje torácico, Heridas por arma de fuego, Medicine, Medicine (General), R5-920
Abstract

La fístula gastropleural es una condición patológica inusual que requiere un alto índice de sospecha diagnóstica. Paciente varón de 30 años, ingresó al Hospital María Auxiliadora por trauma toracoabdominal abierto por proyectil de arma de fuego, con orificio de entrada en hemitórax anterior izquierdo a nivel del 6° espacio intercostal y orificio de salida en hemitórax posterior derecho a nivel de D10; ante la sospecha de hemoneumotórax se colocó tubo de drenaje torácico y posteriormente se realizó una laparotomía exploratoria por sospecha de perforación gástrica. Al noveno día se evidenció 400cc de secreción verdosa mal oliente con restos alimenticios en frasco de drenaje torácico. El diagnóstico de fístula gastropleural se realizó mediante una endoscopia digestiva alta y tomografía espiral multicorte toracoabdominal. El tratamiento fue por laparotomía y toracotomía. En conclusión, la fístula gastropleural por proyectil de arma de fuego es una entidad infrecuente, de diagnóstico múltiple y tratamiento quirúrgico. Este requiere un diagnóstico precoz para un manejo oportuno, de lo que dependerá el pronóstico de los pacientes.

Published
2019
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5. Caso clínico 1: miopatía inflamatoria idiopática. Reporte de caso, Caso clínico 2: disección de aorta. Reporte de caso

Author

Guevara Pacheco, Sergio Vicente, Ortega Nivelo, Italo Ismael, Guevara Pacheco, Sergio Vicente, and Ortega Nivelo, Italo Ismael

Abstract

Background: Idiopathic inflammatory myopathies (IIM) are a group of diseases characterized by muscle weakness and inflammatory infiltrates in muscle tissue, which can affect different organs. Clinical case: a 40-year-old female patient who presented with musculoskeletal pain and muscle weakness in the upper limbs accompanied by scaly papular lesions on the back of the hands and erythema on the eyelids, with increased serum muscle enzymes, suspected IIM, and a muscle biopsy was performed. Reporting perivascular infiltrate, with abnormal electromyography, the Bohan and Peter criteria are applied with a diagnosis of dermatomyositis; Immunosuppressive treatment was started with favorable clinical evolution, medical discharge and outpatient follow-up were decided Clinical case: A 40-year-old female patient who attended for musculoskeletal pain and muscle weakness in the upper limbs accompanied by scaly papular lesions on the back of the hands and erythema at the level of the eyelids, with increased serum muscle enzymes, suspected IIM, a muscle biopsy was performed reporting perivascular infiltrate , with abnormal electromyography, the Bohan and Peter criteria are applied with a diagnosis of dermatomyositis; Immunosuppressive treatment was started with favorable clinical evolution, medical discharge and outpatient follow-up were decided Conclusions: In patients presenting with musculoskeletal pain and muscle weakness associated with skin lesions, IM should be clinically suspected, so the Bohan and Peter criteria should be applied to define the diagnosis. Introducción: la disección de aorta (DA) consiste en una rotura de la capa íntima de la pared del vaso permitiendo el paso de sangre a la capa media separando la luz verdadera de la falsa, es una patología poco frecuente, que puede presentarse en pacientes con antecedentes de traumatismo torácico. Caso clínico: paciente masculino de 35 años, con antecedente de accidente en vehículo motorizado hace 18 meses, acude al servi

Published
2023

6. Análisis de la frecuencia de pacientes politraumatizados en accidentes en motocicleta en la población pediátrica atendida en el Hospital Pediátrico de Sinaloa entre los años 2015 y 2017.

Author

Jáuregui-González, M. E., Zazueta-Tirado, J. M., and Gerardo-Ornelas, C. H.

Abstract

Objectives: Determine the frequency of polytraumatized pediatric patients involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa between 2015 and 2017, as well as to determine the frequency of traumatic brain injuries, thoracic, abdominal, limb injuries, days of hospital stay and mortality. Material and methods: The selected population were patients under 18 years of age who were involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa in a period between January 1st, 2015 and December 31, 2017. Results: The most affected gender was the male with the most frequent age of 14 years, accidents occurred more frequently on Fridays and Saturdays at night. July was the month with the highest frequency of accidents. The number of accidents increased every year. Most of the injured were passengers, 98.4% did not use safety equipment, the most frequent injury was head injury, followed by injuries in lower extremities, upper chest trauma and less frequent abdominal traumatism. Discussion: There is a progressive increase in motorcycle accidents where the pediatric population is involved, the use of helmet is almost zero, most of the patients presented with head trauma, this study serves to see the current situation, as well as being the basis for Subsequent studies and conduct more campaigns for the prevention of motorcycle accidents and encourage the use of helmet in pediatric patients. [ABSTRACT FROM AUTHOR]

Published
2019

7. Traumatismo penetrante cardiaco: caracterización, resultados inmediatos y variables asociadas a morbilidad y mortalidad en pacientes operados.

Author

González L., Roberto, Riquelme U., Alejandra, Fuentes E., Alberto, Canales Z., Jorge, Seguel S., Enrique, Stockins L., Aleck, Jadue T., Andrés, Reyes M., Rodrigo, Saldías F., René, and Alarcón C., Emilio

Abstract

Introduction: Penetrating cardiac trauma (PCT) constitute a permanent surgical challenge due to it characteristics and high mortality. Aim: To describe the findings, outcomes and prognostic factors in PCT. Materials and Method: Cross-sectional descriptive study, review of prospective thoracic trauma protocols and surgical registries. Period January 1990-December 2017. All patients with PCT were included. Various variables are described and analyzed. Univariate and multivariate analysis were performed to identify factors associated with morbidity, neurologic dysfunction and mortality. Results: 220 patients PCT, 209 (95.0%) men, mean age 30.4 ± 13.3, median 27 years. Mechanism: Aggression in 202 (91.8%). The traumatic agent was cold steel in 186 (84.4%) and fire arm in 21 (9.5%). 169 (76.8%) patients presented with tamponade, 103 (46.8%) shock and 20 (9.1%) cardiopulmonary arrest. Approach was sternotomy in 157 (71.4%), left thoracotomy in 58 (26.4%). The most common injured areas were right ventricle in 110 (50.0%), left ventricle in 72 (32.7%). 135 (61.4%) patients needed postoperative ICU and 74 (33.6%) were transfused. Complications occurred in 60 (27.3%). Twenty-one (9.5%) were reoperated. Mortality 28 (12.7%). The postoperative median stay was 6 days (Range 1-150). Prognostic factors were identified. Discussion: Operated PCT are more frequent in men with stab wound, the most common injured area is the right ventricle. The morbidity and mortality is comparable with international series. [ABSTRACT FROM AUTHOR]

Published
2019
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8. Traumatismo torácico contuso

Author

Emilio Alarcón C, Matías Ávalos T., Sebastián Barra M., Claudio Toloza A., Andrés Jadue T, Rodrigo Reyes M., Enrique Seguel S, Felipe Alarcón O., Alejandra Riquelme U., Roberto González L, and Aleck Stockins L

Subjects
0403 veterinary science, 03 medical and health sciences, 0302 clinical medicine, neumotórax, 040301 veterinary sciences, puntaje de gravedad del daño, Traumatismo torácico, cirugía torácica, accidentes del tránsito, 030208 emergency & critical care medicine, 04 agricultural and veterinary sciences, General Medicine, fractura costal
Abstract

Resumen Introducción: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. Objetivo: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. Material y Métodos: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). Discusión: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT.

Published
2019
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9. Cuidados de enfermería en el paciente con traumatismo torácico

Author

Gómez Ballesteros, Adrián, Ballesteros García, Montserrat, Universidad de Valladolid. Facultad de Ciencias de la Salud (Soria), Gómez Ballesteros, Adrián, Ballesteros García, Montserrat, and Universidad de Valladolid. Facultad de Ciencias de la Salud (Soria)

Abstract

Introducción: El trauma grave constituye la primera causa de muerte en las personas jóvenes y la tercera en todos los grupos de edad. El traumatismo torácico presenta un alto índice de mortalidad y su principal mecanismo de lesión es el accidente de tráfico. Se trata de una lesión asociada a múltiples complicaciones y secuelas. El conocimiento del mecanismo lesivo es esencial para comenzar la atención de estos pacientes. Objetivos: Este trabajo pretende describir la valoración, tratamiento y cuidado enfermero del paciente con traumatismo torácico desde el momento en que se produce hasta la recuperación en el ámbito domiciliario. Resultados: El paciente con traumatismo torácico necesita de una valoración y evaluación continuada, así como asegurar un buen cumplimiento del tratamiento médico e implementar intervenciones enfermeras para la prevención de complicaciones y evitar el dolor crónico y la disnea a largo plazo. El seguimiento del paciente después del alta debe basarse en la valoración y el tratamiento del dolor residual, la persistencia de la disnea y la detección de procesos infecciosos y de complicaciones pleurales. Discusión y conclusión: El traumatismo torácico es una patología compleja y a falta de investigación. Una mejor atención prehospitalaria y hospitalaria favorecerían la supervivencia en las primeras 72 horas y, por tanto, permitiría realizar más investigación para estandarizar la atención hospitalaria y el seguimiento., Grado en Enfermería

Published
2021

10. Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography.

Author

Villanueva Campos A, Oikonomou A, Jiménez-Juan L, Gorospe Sarasúa L, and Villanueva Marcos A

Subjects
Humans, Tomography, X-Ray Computed methods, Thoracic Injuries diagnostic imaging, Multiple Trauma
Abstract

Objective: About 60% of multiple trauma patients have thoracic trauma, and thoracic trauma results in the death of 10% of these patients. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute disease, and it helps in the management and prognostic evaluation of patients with high-impact trauma. This paper aims to show the practical points that are key for diagnosing severe non-cardiovascular thoracic trauma by CT., Conclusion: Knowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings., (Copyright © 2023 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2023
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11. Drenajes torácicos en posiciones malas diagnosticados mediante examen de imagen

Author

Pantoja, Gessica Kelem Carvalho, Saraiva, Katleem de Sousa, Castro Neto, Renor Gonçalves de, Silva, Ádria Rodrigues da, and Franco, Ana Paula Mota

Subjects
Drenagem torácica, Tomografía computarizada, Tomografia computadorizada, Drenaje torácico, Thoracic drainage, Traumatismo torácico, Complications, Complicaciones, Thoracic trauma, Trauma torácico, Complicações, Computed tomography
Abstract

Thoracic drainage is a method whereby substances are removed through a drain, whether bloody as in a hemothorax, or air, in the case of pneumothorax, so that it is possible to slide between the pleura and maintain an adequate pulmonary expansion. In the case of patients who have had poor insertion of the drain into the pleural cavity, there may be a worsening of the clinical picture, with reduced ventilation, respiratory failure, occurrence of infections, or even iatrogenic pneumothorax. Objective: To analyze the imaging findings of poorly positioned chest drains on computed tomography. Materials and methods: This research is a retrospective, quantitative study with a descriptive focus, in which data from computed tomography exams provided by the Polimagem Radiodiagnóstico clinic in the municipality of Marabá-PA were used. Results: In the present study, the group with the highest incidence of complications related to inadequate drain placement was male, between 19 and 59 years old, indicated by traumatic causes, the most common location for the insertion of the incorrect drain occurred in the intraparenchymal region causing main complications are pneumothorax, bleeding and in more advanced cases the appearance of fistulas. Conclusion: The findings of the imaging examination were essential for detecting iatrogenesis caused by poorly inserted drains, the results should be expanded to avoid inadequate drain placement, also adopting standardized hospital protocols and training of the health team to use them. El drenaje torácico es un método mediante el cual se extraen sustancias a través de un drenaje, ya sea sanguinolento como en un hemotórax, o aéreo, en el caso de un neumotórax, de manera que se pueda deslizar entre la pleura y mantener una adecuada expansión pulmonar. En el caso de pacientes que han tenido mala inserción del drenaje en la cavidad pleural, puede haber un empeoramiento del cuadro clínico, con ventilación reducida, insuficiencia respiratoria, aparición de infecciones o incluso neumotórax iatrogénico. Objetivo: Analizar los hallazgos de imagen de drenajes torácicos mal posicionados en tomografía computarizada. Materiales y métodos: Esta investigación es un estudio retrospectivo, cuantitativo con enfoque descriptivo, en el que se utilizaron datos de exámenes de tomografía computarizada proporcionados por la clínica de Radiodiagnóstico Polimagem del municipio de Marabá-PA. Resultados: En el presente estudio, el grupo con mayor incidencia de complicaciones relacionadas con la colocación inadecuada del drenaje fue el masculino, entre 19 y 59 años, indicado por causas traumáticas, la ubicación más común para la inserción del drenaje incorrecto ocurrió en el intraparenquimatoso La región que origina las principales complicaciones son el neumotórax, el sangrado y en casos más avanzados la aparición de fístulas. Conclusión: Los hallazgos de la exploración por imágenes fueron fundamentales para detectar iatrogénesis por drenajes mal insertados, los resultados deben ampliarse para evitar la colocación inadecuada de los drenajes, adoptando también protocolos hospitalarios estandarizados y capacitando al equipo de salud para su uso. A drenagem torácica é um método que através no qual através de um dreno é retirado substâncias seja ela sanguinolentas como em um hemotórax, ou o ar, no caso do pneumotórax, para que assim seja possível o deslizamento entre as pleuras e mantenha uma adequada expansão pulmonar. No caso de pacientes em que tiveram má inserção do dreno na cavidade pleural pode haver uma piora do quadro clínico, com uma redução da ventilação, insuficiência respiratória, ocorrência de infeções, ou mesmo o pneumotórax iatrogênico. Objetivo: Analisar os achados de imagem de drenos de tórax mal posicionados na tomografia computadorizada. Materiais e métodos: Esta pesquisa trata-se de um estudo retrospectivo, quantitativo com enfoque descritivo, no qual foi utilizado dados de exames de tomografia computadorizadas disponibilizados pela clínica Polimagem Radiodiagnóstico no município de Marabá-PA. Resultados: No presente estudo o grupo que tem maior incidência de complicações relacionadas ao posicionamento inadequado do dreno foi do sexo masculino, entre 19 a 59 anos, indicado por causas traumáticas, o local mais comum de inserção do dreno incorreto ocorreu na região intraparenquimatosa causando como principais complicações o pneumotórax, sangramentos e nos casos mais avançados o surgimento de fistulas. Conclusão: Os achados do exame de imagem tiveram essencial importância para detectar a iatrogenia causada pelos drenos mal inseridos, os resultados devem ser ampliado para evitar a inadequada colocação de dreno, adotando também protocolos hospitalares padronizados e treinamento da equipe de saúde para sua utilização.

Published
2021

12. Traumatismo torácico contuso

Author

González L., Roberto, Riquelme U., Alejandra, Toloza A., Claudio, Reyes M., Rodrigo, Seguel S., Enrique, Stockins L., Aleck, Jadue T., Andrés, Ávalos T., Matías, Barra M., Sebastián, Alarcón O., Felipe, and Alarcón C., Emilio

Subjects
accidents, traffic, neumotórax, pneumothorax, puntaje de gravedad del daño, Thoracic injury, Traumatismo torácico, cirugía torácica, injury severity score, accidentes del tránsito, rib fractures, thoracic surgery, fractura costal
Abstract

Resumen Introducción: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. Objetivo: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. Material y Métodos: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). Discusión: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT. Background: Thoracic trauma (TT) is a major cause of morbimortality, involved in 25-50% of trauma deaths. Internationally, blunt thoracic trauma (BTT) is the most frequent type of TT. Objective: Our objectives are to describe the clinical characteristics, treatments, morbidity and mortality in patients hospitalized by blunt thoracic trauma (BTT) in our institution. Material and Methods: Cross-sectional descriptive study from january-1981 to december-2017. Prospective database review, surgical protocols and clinical files. The characteristics of the BTT are described and compared. The following trauma severity indices (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS). Results: 4,163 patients were hospitalized because of TT, 1.719 (41.3%) of them with BTT. 1,327 (77.2%)patients were men, average age 46.7 ± 18.8 years-old. We considered isolated TT 966 (56.2%), associated with extrathoracic lesions 753 (43,8%) and 508 (29.6%)with polytraumatism. Mechanism: Traffic accident 838 (48.7%), fall down from a height 279 (16.2%). Lesions and intrathoracic findings: rib fracture 1.294 (75.3%), pneumothorax 752 (43.7%). Treatment: Medical 876 (50.8%), pleurotomy 704 (41%) and thoracic surgery 141 (8.2%). Average hospitalized period 9.2 ± 9.5 days. According to TSI: ISS average 14.1 ± 11.1, RTS-T average 11.5 ± 1.5, TRISS average 6.6. Morbidity in 297 (17.3%), mortality in 68 (4%). Discussion: The TTC was mainly attributed to the traffic accident. Rib fracture was the most common chest injury. The majority of patients required only medical treatment. Mortality was lower than expected according to TSI.

Published
2019

13. Alternativas ao bloqueio epidural torácico no tratamento da dor por fratura de costelas : comparação de estudos em cadáveres

Author

Abrantes, Ana Mafalda Seabra and Fernandes, Paula Cristina Gonçalves Sousa

Subjects
Bloqueio do plano do serrátil anterior, Bloqueio epidural torácico, Bloqueio paravertebral torácico, Traumatismo torácico, Anatomia, Ciências Médicas [Domínio/Área Científica], Bloqueio do plano do eretor da espinha
Abstract

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018 Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2020-02-13T10:38:39Z No. of bitstreams: 1 AnaSAbrantes.pdf: 1285405 bytes, checksum: cdbc89fac041cb753b91734cb44ac070 (MD5) Made available in DSpace on 2020-02-13T14:21:17Z (GMT). No. of bitstreams: 1 AnaSAbrantes.pdf: 1285405 bytes, checksum: cdbc89fac041cb753b91734cb44ac070 (MD5) Previous issue date: 2018

Published
2018

14. Cuidados de enfermagem à pessoa vítima de traumatismo torácico

Author

Meireles, Luís Filipe de Sousa and Martins, Maria de Lurdes

Subjects
Diagnósticos de Enfermagem, Chest Trauma, Traumatismo Torácico, Intervenções de Enfermagem, Nursing interventions, Enfermagem, Nursing diagnoses, Nursing, Enfermagem Médico-cirúrgica
Abstract

Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica O presente relatório de trabalho de projeto surge no âmbito do 4º Curso de Mestrado em Enfermagem Médico-Cirúrgica da Escola Superior de Saúde do Instituto Politécnico de Setúbal, e reflete duas dimensões, a primeira que se prende com a elaboração de um Projeto de Desenvolvimento Académico sobre uma temática selecionada pelo estudante, identificada como sendo um défice de conhecimento, e que, através da elaboração de uma Revisão Integrativa da Literatura, permite a consolidação de conhecimentos mas também o desenvolvimento das competências de mestre. O tema abordado são os Cuidados de Enfermagem à Pessoa Vítima de Trauma Torácico. Por outro lado, o presente relatório aborda uma segunda dimensão, que compreende um Projeto de Aprendizagem de Clínicas, que reflete o desenvolvimento e aquisição das competências comuns e especializadas de um Enfermeiro Especialista em Enfermagem Médico-Cirúrgica, em contexto de estágio clinico que decorreu num Serviço de Urgência Geral de um Centro Hospitalar da Margem Sul do Tejo. Os objetivos do relatório são: enquadrar conceptualmente e teoricamente o trabalho desenvolvido; Apresentar uma Revisão Integrativa de Literatura sobre o tema proposto seguindo a metodologia de projeto; Analisar criticamente as competências específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica desenvolvidas no decorrer dos estágios clínicos e em articulação com a elaboração do Projeto de Desenvolvimento Académico; Analisar criticamente o perfil de competências do Mestre em Enfermagem Médico-Cirúrgica. The present project work report comes under the 4th Master course in Medical-Surgical Nursing at the Health Superior School of the Setúbal Polytechnic Institute, and reflects two dimensions, the development of an Academic Development Project on a theme selected by the student, identified as a lack of knowledge, and that through the development of an Integrative Review of Literature allows the consolidation of knowledge but also the development of master skills. The topic discussed is the nursing care to the person victim of Chest Trauma. On the other hand, the present report deals with a second dimension, which includes a Clinic Learning Project, which reflects the development and acquisition of the common and specialized skills of a nurse specialist in medical-surgical Nursing, in the context of clinical stage held in an Emergency Department of a Hospital Centre on the southern shore of Lisbon. The objectives of the report are: frame conceptually and theoretically work; Perform an Integrative Review of Literature on the topic proposed following the project work methodology; Examine critically the specific skills of the nurse specialist in medical-surgical Nursing developed during clinical stages and in conjunction with the Academic Development Project; Examine critically the skills profile of the Medical-surgical Nursing Master.

Published
2016

15. Factores pronósticos del traumatismo torácico grave en población mayor de 65 años, 1991-2012

Author

Peñasco Martín, Yhivian, Llorca Díaz, Francisco Javier, González Castro, Alejandro, and Universidad de Cantabria

Subjects
Critical care, Elderly, Mortalidad, Anciano, Traumatismo torácico, Chest trauma, Mortality, Cuidados intensivos
Abstract

RESUMEN: En los últimos años se ha producido un aumento de la longevidad y de la calidad de vida en edades cada vez más avanzadas. Las personas de mayor edad presentan una elevada actividad física y una gran independencia funcional. De forma paralela, se ha observado un incremento de la atención sanitaria como consecuencia de sufrir un traumatismo en esta población. Por otra parte, la población de edad avanzada posee características especiales que deben ser tenidas en cuenta tanto en la valoración como en el manejo de estas personas en el contexto de la enfermedad traumática. Sin embargo, los factores pronósticos de gravedad y mortalidad no se conocen con exactitud en esta población. El objetivo de este estudio es conocer los factores pronósticos asociados a una mayor mortalidad durante la estancia en una Unidad de Cuidados Intensivos de aquellas personas con edad igual o mayor a 65 años que ingresan con diagnóstico de traumatismo torácico. Para ello, se realizó un estudio descriptivo retrospectivo sobre la población de la Comunidad Autónoma de Cantabria durante los años 1991 a 2012, analizando variables relacionadas con la valoración inicial tras el traumatismo y determinados parámetros cuyo valor se obtiene en las primeras 24 horas de estancia en la unidad. ABSTRACT: In recent years there has been an increase in longevity and quality of life in increasingly advanced ages. Elderly people have a high physical activity and a high functional independence. In parallel form, there has been an increase in health care as a result of suffering a trauma in this population. Furthermore, the elderly population has special characteristics that must be taken into account in the assessment and management of these people in the context of traumatic disease. However, the prognostic factors of severity and mortality is not known exactly in this population. The aim of this study was to determine the prognostic factors associated with increased mortality during the stay in an intensive care unit for those with age greater than or equal to 65 years admitted with diagnosis of chest trauma. For this reason, a retrospective study on the population of the Autonomous Community of Cantabria was made during the years 1991 to 2012, analyzing related to the initial assessment following trauma and certain parameters variables whose value is obtained in the first 24 hours of stay in unit.

Published
2016

16. Lesión cardíaca inadvertida en trauma toracoabdominal por arma de fuego: presentación de un caso clínico

Author

Navarro Zambrano, Gutenberg Carlos, Barba Pacheco, John, Benítez Pozo, César, Gavidia Miranda, Jésica, Zambrano Solórzano, Martha, Cerruffo Pozo, Nadia, Velasteguí Gavilánez, Renne, Cullacay Buñay, Silvia, Navarro Zambrano, Gutenberg Carlos, Barba Pacheco, John, Benítez Pozo, César, Gavidia Miranda, Jésica, Zambrano Solórzano, Martha, Cerruffo Pozo, Nadia, Velasteguí Gavilánez, Renne, and Cullacay Buñay, Silvia

Abstract

Introducción: la lesión cardíaca constituye una causa altamente letal en trauma penetrante de tórax, siendo las heridas de proyectil las que tienen mayor incidencia de mortalidad, esta dependerá del mecanismo de lesión, áreas cardiacas involucradas y taponamiento cardiaco; el diagnóstico rápido, tratamiento quirúrgico agresivo y técnica empleada, son claves en el pronóstico y supervivencia. Objetivo: demostrar la presencia de lesión cardiaca inadvertida en un paciente con trauma penetrante toracoabdominal en base a la sospecha diagnóstica. Caso de estudio: paciente de 24 años, que sufre trauma toracoabdominal por arma de fuego; se le realizó toracotomía y laparotomía exploradora, con una evolución tórpida e inestabilidad hemodinámica refractaria posoperatoria, por lo que se decide realizar exploración mediastínica que evidenció lesión cardíaca inadvertida en la cara anterior del ventrículo derecho. Discusión: en un estudio las lesiones penetrantes toracoabdominales incurren con una alta mortalidad (31%), y la mortalidad se duplica para pacientes que requieren procedimientos quirúrgicos combinados (59%). En el presente caso si la lesión cardíaca inadvertida no se la diagnosticaba ni se la trataba a tiempo, hubiera sido mortal para el paciente correlacionándose con las estadísticas antes mencionadas. Conclusiones: la alta sospecha diagnóstica por el trayecto del proyectil, permitió una oportuna reintervención del paciente, lográndose una reparación exitosa de una lesión penetrante cardiaca. La evolución postoperatoria fue favorable lográndose estabilizar los signos vitales. Fue dado de alta a los 14 días sin secuelas cardiovasculares.

Published
2017

17. Is it adequate to carry out a chest-CT in patients with mild-moderate chest trauma?

Author

García de Pereda de Blas V, Carreras Aja M, Carbajo Azabal S, and Arana-Arri E

Subjects
Humans, Injury Severity Score, Practice Guidelines as Topic, Thoracic Injuries diagnostic imaging, Tomography, X-Ray Computed standards
Abstract

Mild-moderate blunt chest trauma is defined as a blunt chest trauma that is not caused by a high-energy mechanism, causing thoracic tenderness with or without rib fractures and that has no immediate life-threatening consequences for the patient. It is a frequent clinical situation in the emergency department. The most common radiological techniques that are used in this context are chest X-ray and thoracic computed tomography (CT). The CT scan is set as the gold standard. However, there are no current clinical-radiological guidelines that establish the adequacy of the requests of the CT scan. Therefore, we decided to search for evidence-based recommendations to improve the adequacy of the chest X-ray and CT scan in our daily practice in order to reduce the costs and avoid unnecessary radiation exposure., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Published
2018
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18. Base excess, a useful marker in the prognosis of chest trauma in the geriatric population.

Author

Peñasco Y, González-Castro A, Rodríguez-Borregán JC, and Llorca J

Subjects
Aged, Biomarkers, Female, Humans, Intensive Care Units, Male, Prognosis, Acid-Base Imbalance, Thoracic Injuries metabolism
Abstract

Objective: To determine the usefulness of the determination of base excess in a cohort of elderly patients admitted to an intensive care unit (ICU) with a diagnosis of chest trauma., Material and Method: Two hundred and forty-nine patients were included aged 65 years and over with a diagnosis of thoracic trauma who required admission to the ICU. We made a statistical analysis in order to determine the association of the first base excess levels with mortality during the unit stay., Results: Two hundred and forty-nine patients, with a mean APACHE II score of 16.21±7.87 and 24.45±14.16 ISS. Mean ICU stay was 12.74±16.85 days and the mean hospital stay was 26.55±30.1 days. Statistical analysis showed an association with mortality in patients whose blood pressure was lower than 110mmHg on admission, with an OR=4.11 (95% CI 1.91 to 8.85) compared to patients with blood pressure between 110 and 140mmHg. Those patients who had base excess levels on admission of less than -6mmol/L also showed increased mortality compared to patients with higher levels, with an OR=3.12 (95% CI 1.51 to 6.42)., Conclusions: The presence of a base excess level of less than -6 is associated with increased mortality in elderly patients with initial blood pressure between 110 and 140mmHg, diagnosed with thoracic trauma and who require admission to ICU. Routine measurement of this parameter in this population may show the clinical usefulness of assessing possible hidden hypoperfusion., (Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Published
2017
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19. [Evolution of mortality in severe chest trauma in the elderly patient].

Author

Peñasco Y, Gonzalez-Castro A, Rodriguez-Borregan JC, Muñoz C, and Llorca J

Subjects
APACHE, Aged, Female, Humans, Intensive Care Units, Logistic Models, Male, Retrospective Studies, Thoracic Injuries therapy, Hospital Mortality, Thoracic Injuries mortality
Abstract

Introduction: Persons older than 65 years represent about 30% of all cases requiring care for traumatic injury, and is the fifth leading cause of death. Thus, it is considered important to search for epidemiological parameters that can identify this population group., Patients and Method: A retrospective, observational, and comparative study was conducted on patients aged 65 years and over admitted to the Intensive Care Unit of tertiary hospital with a primary diagnosis of severe chest trauma between January 1992 and January 2012. A logistic regression was performed to determine the probability of hospital death in relation to the year of hospitalisation., Results: The cohort included 235 patients. Univariate logistic regression analysis showed a gradual decrease in the probability of death over the years, with an OR of 0.95 [95% CI; 0.90 to 0.99] for each year of admission after 1992 (P=.029). The multivariate model showed an association of mortality with patient age (OR: 1.08 for year over 65), the score on the scale APACHE II (OR: 1.1 for each point obtained), and need for mechanical ventilation (OR: 5.36)., Conclusions: This study shows a decrease in mortality over the years, with an association that remained after adjustment for different confounding parameters., (Copyright © 2015 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Published
2016
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