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Anesthetic Management of Thoracic Trauma

  • Stephen V. Panaro
  • Tzonghuei Herb Chen
Chapter

Abstract

Thoracic trauma is a morbid business. The American College of Surgeons estimates it is associated with a 10% mortality [1] with 16,000 deaths annually. That represents 25% of all trauma deaths. Considering that injury is the leading cause of death from ages 1 to 45 (more than half of all deaths ages 13–32 and 80% in teenage years) [2] and the leading cause of years of life lost before 75, its impact is enormous [3]. In one analysis, if injury is taken into account, the life expectancy in the United States rockets from 19th in the developed world to first [4]. Since the vital structures in the chest are so well protected by the bony thorax, a great deal of force is required to disrupt them, and they are uncommonly injured in isolation in blunt trauma. Indeed, 70% of the time, insults to the chest are associated with multisystem injury.

Keywords

Anatomy Assessment Management Echocardiography Trauma Traumatic airway Lung isolation Tracheobronchial injury 

Supplementary material

Open image in new windowFig. 51.12 Open image in new windowFig. 51.13 Open image in new windowFig. 51.14
Video 51.1

A mid-esophageal four-chamber view showing a right ventricular contusion with severe right ventricular hypokinesis (MOV 28601 kb)

Video 51.2

A mid-esophageal right ventricular inflow-outflow view showing a tricuspid valve injury (MOV 16652 kb)

Video 51.3

Color Doppler demonstrating severe tricuspid regurgitation associated with a traumatic tricuspid valve injury (MOV 7771 kb)

Video 51.4

A large traumatic pericardial effusion with right atrial systolic collapse, suggesting pericardial tamponade (MOV 16623 kb)

Video 51.5

A large traumatic pericardial effusion with right ventricular diastolic collapse, suggesting pericardial tamponade (MP4 976 kb)

Video 51.6

A view of the descending thoracic aorta demonstrating a traumatic aortic dissection with a thin intimal flap dividing the aorta into true and false lumens (MP4 873 kb)

Video 51.7

A view of the descending thoracic aorta with a “medial flap” demonstrating traumatic aortic disruption (MOV 43659 kb)

Video 51.8

A transgastric left ventricular short axis view showing severe hypovolemia (MP4 873 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stephen V. Panaro
    • 1
  • Tzonghuei Herb Chen
    • 2
  1. 1.Department of AnesthesiaHartford HospitalHartfordUSA
  2. 2.Department of AnesthesiologyWarren Alpert Medical School of Brown University, Rhode Island HospitalProvidenceUSA

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