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Surgery

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Thyroid & Adrenal

Question
84 out of 99
 

Which one of the following would be the most important indication for THORACOTOMY in a patient of thoracic trauma?



A Thoracostomy tube drain output

B Associated injuries

C Hemodynamic status

D X-ray Finding

Ans. A Thoracostomy tube drain output. (REF. SABISTON SURGERY 18TH EDITION PG 643 CHP20)

a. Tube thoracostomy is the most common procedure performed in the management of thoracic trauma. In fact, 85% of patients sustaining chest injuries will require only clinical observation or tube thoracostomy.

b. A large-bore (36-40 French) chest tube should be used in adolescents and adult patients. The proper site of insertion is in the fifth or sixth intercostal space in the midaxillary line.

c. The index finger should be inserted into the pleural space before tube placement to ensure that the pleural cavity has been entered and is free of adhesions and that any intra-abdominal organs have not herniated through the diaphragm.

d. The tube should be advanced posteriorly and superiorly in the pleural cavity. After insertion, the tube should be secured in the skin of the chest wall and connected to a collection system under suction.

e. A chest radiograph is usually obtained after insertion of the chest tube to confirm adequate placement and positioning. General criteria for chest tube removal include absence of air leak and less than 100 mL of fluid drainage over a 24-hour period.

Emergency thoracotomy is indicated after chest trauma in the following situations:

1.

Cardiac arrest (resuscitative thoracotomy)

2.

Massive hemothorax (>1500 mL of blood through the chest tube acutely or >200-300 mL/hr after initial drainage)

3.

Penetrating injuries of the anterior aspect of the chest with cardiac tamponade

4.

Large open wounds of the thoracic cage

5.

Major thoracic vascular injuries in the presence of hemodynamic instability

6.

Major tracheobronchial injuries

7.

Evidence of esophageal perforation.

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