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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, August 2, 2015

Toracotomía en Urgencias

St. Emlyn´s - August 1, 2015 by Natalie May
..."The Eastern Association for the Study of Trauma (EAST) group performed a systematic review of studies in which ED thoracotomy was performed with the intention of separating out the pre-procedure state of the patient and the resulting outcomes. The objective was to evaluate whether ED thoracotomy actually improves the outcome for the patient, when compared with resuscitation without thoracotomy, in a set of possible circumstances in which the patient might present to the ED...
I’m not sure this paper changes my practice at all; if patients are pulseless with signs of life in the context of penetrating thoracic injury causing traumatic cardiac arrest then thoracotomy is potentially life-saving (we knew this already) and for other groups it is helpful to see in writing prognostication we already felt we knew; extra-thoracic penetrating injury carries a worse prognosis than thoracic injury, loss of signs of life is bad, blunt injury is bad.
The recommendations made by the authors are helpful in as much as we can see neurologically intact survival in all groups – this doesn’t justify cracking every chest (of course not!) but in the hands of experienced trauma team leaders there’s an extra piece of evidence to reflect on when making those decisions, which may or may not be difficult after all."

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