TY - JOUR
T1 - Advances in the diagnosis and treatment of thoracic trauma
AU - Feliciano, D. V.
AU - Rozycki, G. S.
PY - 1999
Y1 - 1999
N2 - 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 β-blocker- induced relative hypotension, is rapidly becoming the standard of care throughout the United States.
AB - 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 β-blocker- induced relative hypotension, is rapidly becoming the standard of care throughout the United States.
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U2 - 10.1016/S0039-6109(05)70085-2
DO - 10.1016/S0039-6109(05)70085-2
M3 - Article
C2 - 10625986
AN - SCOPUS:0032752858
SN - 0039-6109
VL - 79
SP - 1417
EP - 1429
JO - Surgical Clinics of North America
JF - Surgical Clinics of North America
IS - 6
ER -