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Health-Process Evidence-Based Clinical Practice Guidelines for Trauma on Thoracic Area

Health-Process Evidence-Based Clinical Practice Guidelines for Trauma on Thoracic Area. Jonathan Malabanan MD OMMC October 11, 2007. Thoracic Trauma. A. Overview of the Problem Concept Common Types Common Causes B. General Management Guidelines Clinical Diagnosis Paraclinical Diagnosis

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Health-Process Evidence-Based Clinical Practice Guidelines for Trauma on Thoracic Area

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  1. Health-ProcessEvidence-BasedClinical Practice GuidelinesforTrauma on Thoracic Area Jonathan Malabanan MD OMMC October 11, 2007

  2. Thoracic Trauma A. Overview of the Problem • Concept • Common Types • Common Causes B. General Management Guidelines • Clinical Diagnosis • Paraclinical Diagnosis • Treatment

  3. Clinical Questions • What is a operational concept of trauma on the thoracic area? Trauma - body injury produced by sudden force Thorax- region

  4. Clinical Questions • What is a operational concept of “Non- Penetrating Thoracic Injury”? - Blunt trauma to the thoracic area

  5. Clinical Questions • What is a operational concept of “Penetrating Thoracic Injury”? -Potential surgical patient

  6. Clinical Questions • How is head trauma classified in terms of mechanism of injury? • Blunt/ non- penetrating trauma • Penetrating trauma

  7. Clinical Questions 5. What are the most common causes of penetrating thoracic injury? • Assault with sharp object • Gunshot Injury

  8. Clinical Questions • What are reliable signs and symptoms (more than 90% certainty) that will indicate that a patient had penetrating thoracic injury? - difficulty of breathing - decreased breath sounds on the affected lung field

  9. Clinical Questions • What are reliable signs and symptoms (more than 90% certainty) that will indicate that a patient had penetrating thoracic injury? - tachycardia - increased respiratory rate

  10. Clinical Questions • What are reliable signs and symptoms (more than 90% certainty) that will indicate that a patient had penetrating thoracic injury? - presence of paradoxical pulse

  11. 8. If a paraclinical diagnostic procedure is needed for trauma to the thoracic area, the most cost effective would be: http://www.diagnosticimaging .com

  12. 9. What are the goals of treatment for the following? • Non- Penetrating Thoracic Injury • Penetrating Thoracic Injury

  13. GOALS OF TREATMENT • Resolution of hemothorax or pneumothorax • Full re- expansion of left lung • Monitor for ongoing bleeding

  14. What is the most cost-effective operative treatment for the following? • Non- Penetrating Thoracic Injury • Penetrating Thoracic Injury

  15. Treatment Options

  16. Practice Level of Evidence • Standards (I) need to be followed • Guidelines (II) suggested • Options (III) considered

  17. Protocol on CTT • May proceed to thoracotomy if: • initial output is ≥ 1000 cc of blood • There is continuous CTT output of more than 150cc/hour

  18. Protocol on Prevention of Posttraumatic Retained HemothoraxDepartment of Surgery, OMMC Hemothorax CTT Thoracotomy >1 Liter >150cc/hr x 4 hrs Suctioning >1/3 retained Hemothorax by CXR Active Observation Gomco < 1/3 retained hemothorax • Turiñgan H, Hernandez D, Joson O. Posttraumatic Retained Hemothorax – • Incidence, Prevention and Management with Suctioning. Published PJSS,2004

  19. What is the role of fluid resuscitation prior to surgery in the treatment of significant thoracic injury? • Fluid resuscitation should be given to avoid hypotension (II)

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