1
|
Becker L, Schulz-Drost S, Schreyer C, Lindner S. [Chest Tube in Thoracic Trauma - Recommendations of the Interdisciplinary Thoracic Trauma Task Group of the German Society for Thoracic Surgery (DGT) and the German Trauma Society (DGU)]. Zentralbl Chir 2023; 148:57-66. [PMID: 36849110 DOI: 10.1055/a-1975-0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
For unstable patients with chest trauma, the chest tube is the method of choice for the treatment of a relevant pneumothorax or haemothorax. In the case of a tension pneumothorax, needle decompression with a cannula of at least 5 cm length should be performed, directly followed by the insertion of a chest tube. The evaluation of the patient should be performed primarily with a clinical examination, a chest X-ray and sonography, but the gold standard of diagnostic testing is computed tomography (CT).A small-bore chest tube (e.g. 14 French) should be used in stable patients, while unstable patients should receive a large-bore drain (24 French or larger). Insertion of chest drains has a high complication rate of between 5% and 25%, and incorrect positioning of the tube is the most common complication. However, incorrect positioning can usually only be reliably detected or ruled out with a CT scan, and chest X-rays proofed to be insufficient to answer this question. Therapy should be carried out with mild suction of approximately 20 cmH2O, and clamping the chest tube before removal showed no beneficial effect. The removal of drains can be safely performed, either at the end of inspiration or at the end of expiration. In order to reduce the high complication rate, in the future the focus should be more on the education and training of medical staff members.
Collapse
Affiliation(s)
- Lars Becker
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Stefan Schulz-Drost
- Klinik für Unfallchirurgie und Traumatologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Christof Schreyer
- Allgemein-/Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland
| | - Sebastian Lindner
- Klinik für Thoraxchirurgie und thorakale Endoskopie, HELIOS Klinikum Erfurt, Erfurt, Deutschland
| |
Collapse
|
2
|
Groombridge CJ, Maini A, Johnny C, McCreary D, Kim Y, Smit DV, Fitzgerald M. Randomised controlled trial in cadavers investigating methods for intubation via a supraglottic airway device: Comparison of flexible airway scope guided versus a retrograde technique. Emerg Med Australas 2021; 34:411-416. [PMID: 34837890 DOI: 10.1111/1742-6723.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A supraglottic airway device (SAD) may be utilised for rescue re-oxygenation following a failed attempt at endotracheal intubation with direct or video laryngoscopy. However, the choice of subsequent method to secure a definitive airway is not clearly established. The aim of the present study was to compare two techniques for securing a definitive airway via the in-situ SAD. METHODS A randomised controlled trial was undertaken. The population studied was emergency physicians (EPs) attending a cadaveric airway course. The intervention was intubation through a SAD using a retrograde intubation technique (RIT). The comparison was intubation through a SAD guided by a flexible airway scope (FAS). The primary outcome was time to intubation. The trial was registered with ANZCTR.org.au (ACTRN12621000995875). RESULTS Four EPs completed intubations using both methods on four cadavers for a total of 32 experiments. The mean time to intubation was 18.2 s (standard deviation 8.8) in the FAS group compared with 52.9 s (standard deviation 11.7) in the RIT group; a difference of 34.7 s (95% confidence interval 27.1-42.3, P < 0.001). All intubations were completed within 2 min and there were no equipment failures or evidence of airway trauma. CONCLUSION Successful tracheal intubation of cadavers by EPs is achievable, without iatrogenic airway trauma, via a SAD using either a FAS or RIT, but was 35 s quicker with the FAS.
Collapse
Affiliation(s)
- Christopher J Groombridge
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Amit Maini
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Cecil Johnny
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - David McCreary
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yesul Kim
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Groombridge CJ, Maini A, Mathew J, Fritz P, Kim Y, Fitzgerald M, Smit DV, O’Reilly G. Comparison of fibre-optic-guided endotracheal intubation through a supraglottic airway device versus hyperangulated video laryngoscopy by emergency physicians: A randomised controlled study in cadavers. HONG KONG J EMERG ME 2021. [DOI: 10.1177/10249079211034272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: After failed endotracheal intubation, using direct laryngoscopy, rescued using a supraglottic airway device, the choice of subsequent method to secure a definitive airway is not clearly determined. Objective: The aim of this study was to compare the time to intubation using a fibre-optic airway scope, to guide an endotracheal tube through the supraglottic airway device, with a more conventional approach using a hyperangulated video laryngoscope. Methods: A single-centre randomised controlled trial was undertaken. The population studied were emergency physicians working in an adult major trauma centre. The intervention was intubation through a supraglottic airway device guided by a fibre-optic airway scope. The comparison was intubation using a hyperangulated video laryngoscope. The primary outcome was time to intubation. The trial was registered with ANZCTR.org.au (ACTRN12621000018819). Results: Four emergency physicians completed intubations using both of the two airway devices on four cadavers for a total of 32 experiments. The mean time to intubation was 14.0 s (95% confidence interval = 11.1–16.8) in the hyperangulated video laryngoscope group compared with 29.2 s (95% confidence interval = 20.7–37.7) in the fibre-optic airway scope group; a difference of 15.2 s (95% confidence interval = 8.7–21.7, p < 0.001). All intubations were completed within 2 min, and there were no equipment failures or evidence of airway trauma. Conclusion: Successful intubation of the trachea without airway trauma by emergency physicians in cadavers is achievable by either fibre-optic airway scope via a supraglottic airway device or hyperangulated video laryngoscope. Hyperangulated video laryngoscope was statistically but arguably not clinically significantly faster than fibre-optic airway scope via supraglottic airway device.
Collapse
Affiliation(s)
- Christopher J Groombridge
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Amit Maini
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Peter Fritz
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Yesul Kim
- National Trauma Research Institute, Melbourne, VIC, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Melbourne, VIC, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Gerard O’Reilly
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Patsch C, Dirisamer F, Schewe B. [Relevance of meniscus loss for the progression of osteoarthritis and treatment options for early arthritis]. Orthopade 2021; 50:366-372. [PMID: 33847792 DOI: 10.1007/s00132-021-04101-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
Meniscal tears are still one of the most frequent lesions in the knee joint. The relevance of meniscus loss for the development of osteoarthritis is undisputed. Meniscus repair, replacement and transplantation play an important role in the treatment of early arthritis, especially when they are a part of a master plan including alignment correction, stabilization and cartilage surgery, if needed. Scientific data show evidence concerning the protection of osteoarthritis, even though a lack of studies including comparison groups has to be admitted.
Collapse
Affiliation(s)
- C Patsch
- Orthopädie & Sportchirurgie, Karl-Leitl-Straße 1, 4048, Linz-Puchenau, Österreich.
| | - F Dirisamer
- Orthopädie & Sportchirurgie, Karl-Leitl-Straße 1, 4048, Linz-Puchenau, Österreich
| | - B Schewe
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Deutschland
| |
Collapse
|