BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationa...BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationally sound and realistic mannequins.The objective of this study is to identify if the chest wall thickness(CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest.METHODS:This is a two-part study.A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins.The literature search was conducted using the Cochrane Central Register of Controlled Trials,MEDLINE,CINAHL,and EMBASE databases from their beginning until the end of May 2012.Key words included chest wall thickness,tension pneumothorax,pneumothorax,thoracostomy,needle thoracostomy,decompression,and needle test.Studies were included if they reported chest wall thickness.RESULTS:For the literature review,4 461 articles were located with 9 meeting the inclusion criteria.Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line.The Laerdal? manikin in the area of the second intercostal space mid clavicular line,right side of the chest was 1.1 cm thick with the left 1.5 cm.The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm.CONCLUSION:Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.展开更多
After analyzing 15 clinical case, 2 of which is especially representative, about perforating injury at the areaintegrates thoracic and abdominal cavities in our hospital from Jan. 1988 to Aug. 2001, the writers have s...After analyzing 15 clinical case, 2 of which is especially representative, about perforating injury at the areaintegrates thoracic and abdominal cavities in our hospital from Jan. 1988 to Aug. 2001, the writers have summarized some therapyon it. First, to avoid delaying surgery operation , those who are injured at that area seriously should be treated with surgeryoperations immediately without X ray and supersonic checks. Second, the positive check results of suspect patients should behelpful for diagnosis, however the negative ones also could not be excluded of the diagnosis clues. The writers think that theconcomitant observation results with the development of illness are most significant. Third, the emphasis of treatments for thoseinjuries should be paid on abdomen. Explore the abdomen is necessary for the situations that abdominal substantial organs bleedand vacuum organs break, thoracic close drainage is sufficient for treating most thoracic trauma cases. It has been improved to beconvenient to check the thoracic cavities by cutting off the diaphragma temporarily if necessary. Fourth, as it was reported that asmany as 97 per cent of patients will have visceral injury dues to abdominal gunshot wound, all gunshot wounds be done with anexploratory laparotomy without hesitation. Fifth, resuscitating of patients as soon as possible is the key to decrease the mortalityand complications. Sixth, acute pancreas injury should be treated as acute pancreatitis.展开更多
BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could ...BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could be encountered in such conditions.CASE SUMMARY A 50-year-old Hispanic male who was a prior smoker presented with shortness of breath.He was diagnosed with SARS-CoV-2.He improved and was discharged with home oxygen.A month later,he presented with sudden onset cough and shortness of breath.Chest X-ray showed development of right-sided tension pneumothorax,right pleural effusion and an air-filled cystic structure.Computed tomography thorax showed findings suggestive of pulmonary coccidioidomycosis.Coccidioides antigen was positive,and fluconazole was initiated.For pneumothorax,a pigtail catheter was placed.The pigtail chest tube was later switched to water seal,unfortunately,the pneumothorax re-expanded.Another attempt to transition chest tube to water seal was unsuccessful.Pigtail chest tube was then swapped to 32-Fr chest tube and chemical pleurodesis was performed.This was later transitioned successfully to water seal and finally removed.He was discharged on a four-week oral course of fluconazole 400 mg and was to follow up closely as an outpatient for continued monitoring.CONCLUSION Pneumothorax is associated with a worse prognosis,especially with comorbidities such as diabetes,immunosuppression and malignancy.Suspicion for concomitant fungal infection in such patients should be high and would necessitate further investigation.展开更多
文摘BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationally sound and realistic mannequins.The objective of this study is to identify if the chest wall thickness(CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest.METHODS:This is a two-part study.A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins.The literature search was conducted using the Cochrane Central Register of Controlled Trials,MEDLINE,CINAHL,and EMBASE databases from their beginning until the end of May 2012.Key words included chest wall thickness,tension pneumothorax,pneumothorax,thoracostomy,needle thoracostomy,decompression,and needle test.Studies were included if they reported chest wall thickness.RESULTS:For the literature review,4 461 articles were located with 9 meeting the inclusion criteria.Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line.The Laerdal? manikin in the area of the second intercostal space mid clavicular line,right side of the chest was 1.1 cm thick with the left 1.5 cm.The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm.CONCLUSION:Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.
文摘After analyzing 15 clinical case, 2 of which is especially representative, about perforating injury at the areaintegrates thoracic and abdominal cavities in our hospital from Jan. 1988 to Aug. 2001, the writers have summarized some therapyon it. First, to avoid delaying surgery operation , those who are injured at that area seriously should be treated with surgeryoperations immediately without X ray and supersonic checks. Second, the positive check results of suspect patients should behelpful for diagnosis, however the negative ones also could not be excluded of the diagnosis clues. The writers think that theconcomitant observation results with the development of illness are most significant. Third, the emphasis of treatments for thoseinjuries should be paid on abdomen. Explore the abdomen is necessary for the situations that abdominal substantial organs bleedand vacuum organs break, thoracic close drainage is sufficient for treating most thoracic trauma cases. It has been improved to beconvenient to check the thoracic cavities by cutting off the diaphragma temporarily if necessary. Fourth, as it was reported that asmany as 97 per cent of patients will have visceral injury dues to abdominal gunshot wound, all gunshot wounds be done with anexploratory laparotomy without hesitation. Fifth, resuscitating of patients as soon as possible is the key to decrease the mortalityand complications. Sixth, acute pancreas injury should be treated as acute pancreatitis.
文摘BACKGROUND The incidence of secondary coinfections particularly fungal infections among severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is not well described.Little is known of the complications that could be encountered in such conditions.CASE SUMMARY A 50-year-old Hispanic male who was a prior smoker presented with shortness of breath.He was diagnosed with SARS-CoV-2.He improved and was discharged with home oxygen.A month later,he presented with sudden onset cough and shortness of breath.Chest X-ray showed development of right-sided tension pneumothorax,right pleural effusion and an air-filled cystic structure.Computed tomography thorax showed findings suggestive of pulmonary coccidioidomycosis.Coccidioides antigen was positive,and fluconazole was initiated.For pneumothorax,a pigtail catheter was placed.The pigtail chest tube was later switched to water seal,unfortunately,the pneumothorax re-expanded.Another attempt to transition chest tube to water seal was unsuccessful.Pigtail chest tube was then swapped to 32-Fr chest tube and chemical pleurodesis was performed.This was later transitioned successfully to water seal and finally removed.He was discharged on a four-week oral course of fluconazole 400 mg and was to follow up closely as an outpatient for continued monitoring.CONCLUSION Pneumothorax is associated with a worse prognosis,especially with comorbidities such as diabetes,immunosuppression and malignancy.Suspicion for concomitant fungal infection in such patients should be high and would necessitate further investigation.
