![RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
Penetrating injuries are defined as an injury that occurs
when a foreign object breaks through the skin and enters
the tissues of the body, creating an open wound. The
foreign object may either remain within the tissues, or be
retracted from the same entry wound, or may pass
through the entire depth of the tissues and exit through
another site.
These range of injuries are usually seen in combat-
associated injuries or violent crime-related injuries.
Mechanism of penetrating injuries are usually by gunshot
or stabbings. Assessment for penetrating injuries require
astute history taking, systematic clinical examination and
appropriate adjuncts such as X-ray and CT scan. Failure to
complete these steps may result in a missed finding and
may result in dire consequences.
Introduction
Case Report
References
He underwent a Median Sternotomy + Femoral-Femoral Bypass
+ Repair of SVC tear + Dacron grafting of the Brachiocephalic
Artery + Removal of the retained blade. Patient recuperated
well post op and was discharged home after 35 days
Conclusion
Penetrating injuries may appear subtle on initial presentation
but a thorough primary and secondary survey may expose a
more sinister presentation with critical outcomes if not
detected systematically and promptly. Especially penetrating
injuries in which clinical severity does not correspond to the
magnitude of mechanism of injury. In this case, had they not
completed the secondary survey with a Chest X-ray, this
patient would have been sent home with the blade still
concealed within!
Discussion
Thoracic injuries account for 20-25% of deaths due to trauma
and contribute to 25-50% of the remaining deaths. Improved
prehospital and perioperative care have resulted in an
increasing number of critically injured but potentially
salvageable patients presenting to trauma centers.
Injuries to the thoracic great vessels occur in about
5 % of gunshot wounds and 2 % of stab wounds to
the chest (12). Most of the victims reach the hospital
dead or in severe shock. The overall mortality of thoracic
aortic injuries is higher than 90 % and in subclavian vascular
injuries about 65 % (12, 13, 14). Many of these victims require
an emergency room thoracotomy (about 80 % of aortic injuries
and 23 % of subclavian vascular injuries) and the survival is
very poor.
Chest radiography remains the basis for initiating other
investigations. CT scanning is rapidly evolving into a primary
diagnostic tool because of its ability to image various
intrathoracic structures.
There has been an incremental increase in the utilization of
cardiothoracic surgeons over the last 10 years for thoracic
trauma operative intervention and with little data available,
it does appear to have resulted in improved patient outcomes.
1. Scandinavian Journal of Surgery 91: 41–45, 2002 PENETRATING INJURIES OF THE CHEST:INDICATIONS FOR OPERATION D.
Demetriades, G. C. Velmahos Department of Surgery, Division of Trauma and Critical Care, University of Southern
California, Los Angeles California, U.S.A
2. Penetrating Chest Trauma Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Jeffrey C Milliken, MD
3. Penetrating chest trauma (PMID:8432259) Jorden RC Department of Emergency Medicine, Maricopa Medical Center,
Phoenix, Arizona. Emergency Medicine Clinics of North America [1993, 11(1):97-106]
A 28 year old gentleman walked into the emergency
department of a district hospital after an alleged robbery in
his home.
Clinical examination showed multiple stab incision wounds
over Zone I of the left neck and left shoulder and upper
chest with minimal bleeding.
A CTA of the neck and thorax showed a stab wound injury
with embedded metallic blade traversing the left
supraclavicular region and superior mediastinum with the tip
of the blade appears to be within the right subclavian vein at
the level of its entrance into SVC.
.
1. Trauma Unit,General Surgery Department, Hospital Sultanah Aminah Johor Bahru
2. Cardiothoracic Unit, Hospital Sultanah Aminah Johor Bahru
3. Head of Unit, General Surgery Department, Hospital Sultanah Aminah Johor Bahru
K Abdulah 1, AM Khairi 1, Y Mohamed 1, RI Alwi 1, V Simon 2, AKB Gunn 3.
INJURED BY CONCEALED WEAPON
Entry wound
Metal blade
extracted
from body
(21cm length)
(Chest X ray on arrival) (CTA image sagittal cut)](https://image.slidesharecdn.com/singtraumaposter2014corrected-150323060014-conversion-gate01/85/Injury-by-concealed-weapon-a-penetrating-trauma-case-1-320.jpg)
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- 1. RESEARCH POSTER PRESENTATION DESIGN © 2012 www.PosterPresentations.com Penetrating injuries are defined as an injury that occurs when a foreign object breaks through the skin and enters the tissues of the body, creating an open wound. The foreign object may either remain within the tissues, or be retracted from the same entry wound, or may pass through the entire depth of the tissues and exit through another site. These range of injuries are usually seen in combat- associated injuries or violent crime-related injuries. Mechanism of penetrating injuries are usually by gunshot or stabbings. Assessment for penetrating injuries require astute history taking, systematic clinical examination and appropriate adjuncts such as X-ray and CT scan. Failure to complete these steps may result in a missed finding and may result in dire consequences. Introduction Case Report References He underwent a Median Sternotomy + Femoral-Femoral Bypass + Repair of SVC tear + Dacron grafting of the Brachiocephalic Artery + Removal of the retained blade. Patient recuperated well post op and was discharged home after 35 days Conclusion Penetrating injuries may appear subtle on initial presentation but a thorough primary and secondary survey may expose a more sinister presentation with critical outcomes if not detected systematically and promptly. Especially penetrating injuries in which clinical severity does not correspond to the magnitude of mechanism of injury. In this case, had they not completed the secondary survey with a Chest X-ray, this patient would have been sent home with the blade still concealed within! Discussion Thoracic injuries account for 20-25% of deaths due to trauma and contribute to 25-50% of the remaining deaths. Improved prehospital and perioperative care have resulted in an increasing number of critically injured but potentially salvageable patients presenting to trauma centers. Injuries to the thoracic great vessels occur in about 5 % of gunshot wounds and 2 % of stab wounds to the chest (12). Most of the victims reach the hospital dead or in severe shock. The overall mortality of thoracic aortic injuries is higher than 90 % and in subclavian vascular injuries about 65 % (12, 13, 14). Many of these victims require an emergency room thoracotomy (about 80 % of aortic injuries and 23 % of subclavian vascular injuries) and the survival is very poor. Chest radiography remains the basis for initiating other investigations. CT scanning is rapidly evolving into a primary diagnostic tool because of its ability to image various intrathoracic structures. There has been an incremental increase in the utilization of cardiothoracic surgeons over the last 10 years for thoracic trauma operative intervention and with little data available, it does appear to have resulted in improved patient outcomes. 1. Scandinavian Journal of Surgery 91: 41–45, 2002 PENETRATING INJURIES OF THE CHEST:INDICATIONS FOR OPERATION D. Demetriades, G. C. Velmahos Department of Surgery, Division of Trauma and Critical Care, University of Southern California, Los Angeles California, U.S.A 2. Penetrating Chest Trauma Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Jeffrey C Milliken, MD 3. Penetrating chest trauma (PMID:8432259) Jorden RC Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona. Emergency Medicine Clinics of North America [1993, 11(1):97-106] A 28 year old gentleman walked into the emergency department of a district hospital after an alleged robbery in his home. Clinical examination showed multiple stab incision wounds over Zone I of the left neck and left shoulder and upper chest with minimal bleeding. A CTA of the neck and thorax showed a stab wound injury with embedded metallic blade traversing the left supraclavicular region and superior mediastinum with the tip of the blade appears to be within the right subclavian vein at the level of its entrance into SVC. . 1. Trauma Unit,General Surgery Department, Hospital Sultanah Aminah Johor Bahru 2. Cardiothoracic Unit, Hospital Sultanah Aminah Johor Bahru 3. Head of Unit, General Surgery Department, Hospital Sultanah Aminah Johor Bahru K Abdulah 1, AM Khairi 1, Y Mohamed 1, RI Alwi 1, V Simon 2, AKB Gunn 3. INJURED BY CONCEALED WEAPON Entry wound Metal blade extracted from body (21cm length) (Chest X ray on arrival) (CTA image sagittal cut)