The pre-hospital management of life-threatening chest injuries: A consensus statement from the Faculty of Pre-Hospital Care

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RFE Traumatismes thoraciques

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Prehospital management of chest injuries

The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh

Lee C. et AL. Emerg Med J 2007;24:220–224

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Un document un peu ancien des nos confrères britanniques mais qui reste d'actualité.

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This paper provides a guideline for the management of prehospital chest injuries after a consensus meeting held by the

Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK, in January 2005. An overview of

the prehospital assessment, diagnosis and interventions for life threatening chest injury are discussed, with the application of

skills depending on the training, experience and competence of the individual practitioner

Blessés thoraciques: Données UK

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

Poon H. et All. Injury. 2013 Feb 20. pii: S0020-1383(13)00073-9.

INTRODUCTION:

Thoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries.

METHODS:

The UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3). All UK soldiers, coalition forces and local civilians were included.

RESULTS:

During the study period 7856 patients were admitted because of trauma, 826 (10.5%) of whom had thoracic injury. Thoracic injury-related mortality was 118/826 (14.3%). There were no differences in gender, age, coalition status and mechanism of injury between survivors and non-survivors. Survivors had a significantly higher GCS, Revised Trauma Score and systolic blood pressure on admission to a Role 3 facility. Multivariable regression analysis identified admission systolic blood pressure less than 90, severe head or abdominal injury and cardiac arrest as independent predictors of mortality.

 

CONCLUSIONS:

Blast is the main mechanism of thoracic wounding in the recent conflicts in Iraq and Afghanistan. Thoracic trauma in association with severe head or abdominal injuries are predictors of mortality, rather than thoracic injury alone. Deploying surgeons require training in thoracic surgery in order to be able to manage patients appropriately at Role 3.

Commentaires

La plupart des traumatisés ne nécessite pas de chirurgie. Les survivants arrivent plus vite mais il ne semble pas qu'un délai un peu plus long soit associé avec une surmortalité. La gravité du traumatisme thoracique n'apparait pas être lié avec la mortalité. il existeune amélioration du pronostic rapporté à l'amélioration de la prise en charge globale.

Le triangle de sécurité pour la thoracostomie

Chest drain insertion is not a harmless procedure – are we doing it safely ?

Elsayed H. et All. Interactive CardioVascular and Thoracic Surgery 11 (2010) 745–749

Près de la moitié des drains thoraciques ne sont pas posés au bon endroit

 

On rappelle la notion de triangle de sécurité (Le BTS Guideline)

http://www.surgeryjournal.co.uk/article/S0263-9319%2811%2...

La réalisation d'une thoracostomie au doigt et l'insertion d'un drain doit se faire de manière sécuritaire.

Le choix de la voie axillaire est certainement à privilégier.