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   2017| January-December  | Volume 2 | Issue 1  
    Online since December 15, 2017

 
 
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REVIEW ARTICLE
Chest trauma: “Damage Control” Begins in the emergency room
Bradley J Phillips, Lauren Turco
January-December 2017, 2(1):3-9
DOI:10.4103/jctt.jctt_3_17  
Background: Patients with severe thoracic injuries and subsequent physiological decline may not be candidates for initial definitive treatment. Despite limited data, this subset of patients may benefit from the implementation of thoracic damage control, which should begin in the emergency room. Methods: A literature search was conducted through Medline following PRISMA guidelines. Articles that focused on damage control surgery, the use of damage control techniques in traumatic injuries, and the use of damage control in civilian populations were selected. Due to the paucity of literature and lack of Level I evidence on this subject, studies published in any year were considered. Results: A search of the literature yielded 119 studies. Most of these were excluded based on inclusion and exclusion criteria. Thirty-five articles were selected for review. The majority of these were classified as Level III, IV, or V evidence. Limitations: Limitations of this article are similar to all PRISMA-guided review articles: The dependence on previously published research and availability of references. Conclusion: Effective “Damage Control” following a traumatic injury begins with initial management in the emergency department, which is followed by an abbreviated operation, equally aggressive critical care, and a planned reexploration. Additional studies are required to examine the adaptation of specific damage control techniques to thoracic injuries, but patients with severe chest trauma can benefit from initiation of damage control strategies in the emergency room.
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EDITORIAL
The emerging educational power of the journal of cardiothoracic trauma: Highlights of direct lethal injuries
Moheb A Rashid
January-December 2017, 2(1):1-2
DOI:10.4103/jctt.jctt_5_17  
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SURGICAL TECHNIQUES AND VIDEOS
Intercostal pericardial window: A Safe, expedient, and effective minimally invasive technique
Moheb A Rashid, Fredrik Holmner
January-December 2017, 2(1):21-22
DOI:10.4103/jctt.jctt_4_17  
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CASE REPORTS
Late cardiac tamponade after cardiac trauma: A case report and a review
Bruno Jose da Costa Medeiros, Hugo Marlon de Castro Negreiros, Luiz da Gama Pessoa
January-December 2017, 2(1):10-13
DOI:10.4103/jctt.jctt_6_17  
The pericarditis is an inflammation process of the pericardium with lots of causes, primary and secondary. It may progress with pericardial effusion and/or constrictive pericarditis. The presentation as late cardiac tamponade due to trauma is a rare clinical condition and may occur days or weeks after trauma. We report a case observed in a trauma hospital of Manaus-Amazonas, Brazil periphery. The patient presented to the hospital 18 days after a chest trauma with signs and symptoms of cardiac tamponade: tachycardia, turgid jugular veins, inferior limbs swollen, presenting breathing difficulties, and supine position not tolerated. He underwent exploratory thoracotomy, and a thick pericardium with purulent effusion was found. It is important to suspect cadiac injury in patients who are victims of trauma on cardiac box, to observe that the focused assessment sonography for trauma is used, but it has its limitations. It is 90%–95% accurate for the presence of pericardial fluid for the experienced operator. Concomitant hemothorax may account for both false-positive and false-negative ultrasound examinations.[2] When necessary, the subxiphoid exploration must be done. The possibility of occult cardiac lesion or silent cardiac wound should always be considered in patients with chest trauma by knife or gunshot on Zieddler area or cardiac box, to prevent a late cardiac tamponade or pericarditis.
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Complex cardiac stab wound
Bruno José da Costa Medeiros, Ricardo Silva de Morais
January-December 2017, 2(1):17-20
DOI:10.4103/jctt.jctt_6_16  
A 50-year-old male come to the hospital victim of damage with a knife to anterior chest (precordial region) after a fight 1 h before. Cardiac tamponade was discovered by focused assessment sonography for trauma and was positive with fluid in pericardial sac. The patient was taken to the operating room. A left anterior thoracotomy was performed. There were three cardiac lesions: One was on the right ventricle, another was very near the left coronary artery (descending anterior branch), and the last one was on pulmonary artery trunk. All the three lesions were corrected with horizontal sutures with prolene 3-0, the lesion near the coronary artery was corrected with a horizontal suture under the artery. Complex cardiac wound is always a challenger to the surgeon, in this case, a cardiac lesion was so near the left coronary artery, a suture over the artery could lead to a myocardial infarction and even death of the patient.
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Traumatic tension pneumopericardium: A rare complication
P Vivekananthan, Mudalipalayam N Sivakumar, Mohamed Hisham, S Lakshmikanthcharan
January-December 2017, 2(1):14-16
DOI:10.4103/jctt.jctt_12_16  
A 36- year old male was admitted with shock following a road traffic accident. The patient had a low Glasgow Coma Scale score of 8/15 for which he was ventilated and intubated. Computed tomography scan showed pneumomediastinum and pneumopericardium along with left-sided hemopneumothorax. Hemopneumothorax was addressed with an intercostal drain. There was no further blood loss. Persisting hemodynamic compromise needing inotropic support prompted a diagnosis of tamponading effect of pneumopericardium. Pericardiocentesis was performed which resulted in immediate hemodynamic stability. The patient was discharged from intensive care unit after tracheostomy and had a complete recovery. Tension pneumopericardium is an extremely rare condition which can be fatal if left untreated. Prompt suspicion, diagnosis, and treatment of the condition in a hemodynamically unstable trauma patient can be lifesaving.
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IMAGES IN CARDIOTHORACIC TRAUMA
Pneumomediastinum as Revealed during Video-assisted Thoracoscopic Surgery
Moheb A Rashid
January-December 2017, 2(1):23-23
DOI:10.4103/jctt.jctt_2_17  
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