A plea for sensible management of myocardial contusion

Article Abstract:

There is little information available on the physiological effects of blunt trauma to the heart. Diagnosis and treatment of this injury has been based on extensive experience with ischemic heart injury (caused by inadequate blood flow to the heart muscle) which was due to atherosclerotic coronary artery disease (cholesterol plaque formation on the lining of the artery wall). It has been experimentally shown that blunt heart injury caused by trauma results in only transient decreased function, and blood supply to the heart muscle is quickly restored. Many people sustain chest injury in motor vehicle accidents. A prospective study was undertaken to evaluate the clinical course of blunt heart injury and to define the risk of life-threatening complications. Over a three-year period, 280 patients sustained blunt chest trauma and were admitted to the surgical intensive care unit for evaluation. There were 35 patients (13 percent) who had blunt heart injury. Diagnosis was based on transient changes in the electrocardiogram, and/or tests of enzyme levels. Two patients died, and seven were treated for heart rhythm irregularities or heart failure; all deaths and complications occurred within 12 hours of injury. No other patients had cardiac symptoms. It is concluded that there is a low incidence of heart complications in patients at risk for blunt injury to the heart. If complications do occur, this is generally within 12 hours of injury, and heart contusion can be identified within 24 hours by electrocardiogram and enzyme levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Complications and side effects, Blunt trauma

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A unified approach to the torn thoracic aorta

Article Abstract:

A difficult injury to treat is a torn thoracic aorta, the chest portion of the main trunk of the arterial circulation which conveys oxygenated blood from the heart to the tissues of the body. Often patients with this injury die before they reach the hospital. There is controversy over the best method of aortic repair. Treatment is directed toward avoiding ischemia (inadequate blood supply) to the spinal cord and subsequent paraplegia (paralysis of both legs). This report describes the authors' experience in treating 12 patients who sustained a blunt tear to the thoracic aorta. Ten of these injuries occurred as a result of head-on motor vehicle accidents. The first six patients underwent a procedure in which a graft was placed within the lumen of the aorta; the more recently treated six patients underwent partial left heart bypass. Graft placement had to be abandoned in two patients, instead, a sutured repair was performed. Two additional patients suffered spinal cord ischemia and two developed hypertension. Further graft placements were not performed. Partial left heart bypass (left atrial-femoral bypass) has been successful in all subsequent patients treated by the authors. A review of the current literature reveals favorable results with this technique of repairing a torn thoracic aorta. Of 29 reported cases, there were two deaths (7 percent) and no incidence of paraplegia. The authors recommend the atrial-femoral bypass method of repair for torn thoracic aorta. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Aorta, Heart surgery

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Validating the selective management of penetrating neck wounds

Article Abstract:

There is disagreement over the benefits of mandatory versus selective surgical exploration following penetrating injury of the neck. A report is presented of 188 patients with penetrating wounds at the front of the neck who were treated selectively. These patients were treated over a 12-year period. Stabbing accounted for 77 percent of the injuries. Immediate neck exploration was carried out on the 69 patients (37 percent) who presented with severe symptoms, such as persistent shock, profuse bleeding or evolving stroke. The remaining patients (119) were carefully monitored in the hospital; diagnostic tests were conducted, based on the location and cause of the wound. Eighty-seven percent of the patients who underwent surgery were found to have significant injuries. In the observed group of 119 patients, only one patient (0.8 percent) had hidden injury which required surgery at a later time. Patients who were observed remained in the hospital, on average, 1.7 days; patients who underwent surgery and had negative findings were hospitalized for an average of 4.2 days. Patients who underwent surgical exploration and were found to have injuries remained in the hospital, on average, 8.4 days. These results support the selective use of neck exploration for patients who have suffered penetrating wounds to the front of the neck. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Wounds and injuries, Wound care, Neck, Neck injuries, Diagnosis, Surgical, Surgical diagnosis, Surgical emergencies, Penetrating wounds

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