Thoracic injuries

That same year, 19 children (11.3% of the 168 fatalities) died in the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995 (Quintana et al., 1997). Sixteen of the children who died were seated by the window of the day care center at the time of the explosion. Among the 19 dead children, 90% sustained skull fractures, with 79% sustaining cerebral evisceration 37% suffered abdominal or thoracic injuries 31% had amputations 47% had arm and 26% had leg fractures 21% were burned and 100% had extensive cutaneous contusions, avulsions, and lacerations (Quintana et al., 1997). Forty-seven children sustained nonfatal injuries, with seven requiring hospitalization (Quintana et al., 1997). Again, hospitalized children sustained severe skull and brain injuries, extremity fractures, amputations, and burns (Quintana et al., 1997). 

In a study to prepare for clinical trial, a PLGA scaffold was seeded with human fetal neural stem cells and implanted in incomplete thoracic injuries (unilateral removal of the lateral part of T9—TIO) in African green monkeys (Pritchard et al., 2010). Only... 

Shanmuganathan K, Mirvis SE (1999) Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am 37 533-551, vi... 

Thoracic injuries are common and may be either blimt (from impact) or penetrating (from fragments or impact). In addition, pneumothorax may occur as a primary blast effect. The management of these injuries follows conventional protocols, although some care should be taken if ventilatory support is required (see below). 

Thoracic injury may not be confined to pulmonary tissue. Rib fractures in the posterior angles may occur with high blast loads but are far more commonly tertiary impact injuries. Mucosal bruising in the upper airways with stripping of the epithelium may also occur... 

It was emphasized that any thoracic penetration may result in acute life-threatening injuries such as tension pneumothorax, hemothorax, massive cardiac injury with tamponade, great vessel injury, hemoptysis, and lung coUapse. Thermoset mbber bullets can also cause serious injuries, as shown in Figure 7.2. 

Centers for Disease Control and Prevention. Update Fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in the American Thoracic Society/CDC recommendations. Morb Mortal Wkly Rep MMWR 2001 50(34) 733-735. 

Boyle EM, Jr., Kovacich JC, Hebert CA, et al. Inhibition of interleukin-8 blocks myocardial ischemia-reperfusion injury. J Thorac Cardiovasc Surg 1998 116(1) 114-121. 

Nogo-A. Treatment with IN-1 promoted axonal regeneration and behavioral recovery in rats after thoracic spinal cord injury. These exciting results have since been confirmed using local intrathecal pump infusions of recombinant IN-1 Fab fragments or novel anti-Nogo-A antibodies [9]. 

Pain Action Unknown but may stimulate opioid sites, sedation and analgesia Dose Adults. Self administered inhalation (generally 25-50% w/ oxygen) until pain relief or pt drops mask/falls asleep Peds. Same as adult (onset w/in 2-5 min) Caution [ , ] Do not use after full meal Contra EtOH intox AMS following head injury COPD, thoracic trauma Disp Supplied in blue cylinders SE N/V, Light-headedness, AMS and hallucinations Interactions T CNS depression Wf opiates, EtOH, sedatives EMS Do not strap mask to pt s face, allow pt to hold the mask to their face dosing is self-limiting when pt drops mask d/t CNS depression typically used for bums and fractures... 

Khan TA, Bianchi C, Ruel M, Voisine P, Sellke FW (2004) Mitogen-activated protein kinase pathways and cardiac surgery. J Thorac Cardiovasc Surg 127(3) 806-811 Khimenko PL, Moore TM, Hill LW, Wilson PS, Coleman S, Rizzo A, Taylor AE (1995) Adenosine A2 receptors reverse ischemia-reperfusion lung injury independent of P-receptors. J Appl Physiol 78(3) 990-996... 

Maxey TS, Enelow RI, Gaston B, Kron IL, Laubach VE, Doctor A (2004) Tumor necrosis factor-alpha from resident lung cells is a key initiating factor in pulmonary ischemia-reperfusion injury. J Thorac Cardiovasc Surg 127(2) 541—547 Mayer AM, Pittner RA, Lipscomb GE, Spitzer JA (1993) Effect of in vivo TNF administration on superoxide production and PKC activity of rat alveolar macrophages. Am J Physiol Lung Cell Mol Physiol 264(1 Pt 1) L43-L52... 

Naidu BV, Krishnadasan B, Farivar AS, Woolley SM, Thomas R, Van Rooijen N, Verrier ED, Mulligan MS (2003) Early activation of the alveolar macrophage is critical to the development of lung ischemia-reperfusion injury. 1 Thorac Cardiovasc Surg 126(l) 200-207... 

Sawa, Y., Ichikawa, H., Kagisaki, K., Ohata, T., and Matsuda, H., Interleukin-6 derived from hypoxic myocytes promotes neutrophil-mediated reperfusion injury in myocardium. J. Thorac. Cardiovasc. Surg. 116, 511-517 (1998). 

Nakamura H, del Nido PJ, Jimenez E, et al, Age-related differences in cardiac susceptibility to ischemia/reperfusion injury. Response to deferoxamine, J Thorac Cardiovasc Surg 1992 ... 

Nicholson SC, Squier M, Ferguson DJ, et al. Effect of desferrioxamine cardioplegia on ischemia-reperfusion injury in isolated rat heart, Ann Thorac Surg 1997 63(4) 1003-ION. 

Ueda H, Sawa Y Matsumoto K, et al. Gene transfection of hepatocyte growth factor attenuates reperfusion injury in the heart. Ann Thorac Surg I 999 67 1726-173 I. 

ParkJL, Lucchesi BR, Mechanisms of myocardial reperfusion injury. Ann Thorac Surg I 999 68 1 905-1912. 

Chen ER Bittner HB, Davis RD, Van Trigt R Folz R. Physiological effects of extracellular superoxide dismutase transgene overexpression on myocardial function after ischemia and reperfusion injury. J Thorac Cardiovasc Surg 1998 I 15 450-458. 

Musculoskeletal All extremities, the pelvic ring, peripheral pulses, and thoracic and lumbar spine should be assessed. If necessary. X-rays should be obtained when the patient is stabilized. Hemorrhage from pelvic fractures is not uncommon. Hand, foot, and wrist fractures and soft tissue injuries may be missed. Frequent reevaluation should take place to identify these. 

Multiple sclerosis Preganglionic Spinal birth injury Tuberculosis Pancoast tumor Aortic aneurysm Enlarged mediastinal glands Enlargement of thyroid Lymphadenopathy Thoracic neuroblastoma Pulmonary mucormycosis Trauma... 

Most lesions causing Homer s syndrome involve the preganglionic neuron. Patients with such lesions may have an apical lung tumor (Pancoast tumor) or breast malignancy that has spread to the thoracic outlet. The patient may also have a history of surgery or trauma to the neck, chest, or cervical spine. Nonoperative injuries to... 

DeBoer, D. A. Clark, R. E. Iron chelation in myocardial preservation after ischemia-reperftision injury the importance of pretreatment and toxicity. Ann. Thorac. Surg. 53 412-418 1992. 

Cochran, R.P. Kunzelman, K.S. Vocelka, C.R. Akimoto, H. Thomas, R. Soltow, L.O. Spiess, B.D. Perfluorocarbon emulsion in the cardiopulmonary bypass prime reduces neurologic injury. Ann. Thorac. Surg. 1997, 63, 1326-1332. 

Postural headache after thoracic paravertebral nerve anesthesia, and probably reflecting dural entry, has been reported (343). Nerve root damage is another possible complication. Hematuria due to injury to the kidney or ureter is an unusual complication of lumbar paravertebral sympathetic block (344). 

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