Traumatic diaphragmatic rupture and left chest wall herniation

Multimedia Manual of Cardio-Thoracic Surgery · 2026-01-07

Blunt diaphragmatic rupture is a rare injury with a high mortality rate. The pathophysiological mechanism of diaphragmatic rupture is hypothesized as an increase in intra-abdominal pressure leading to muscular disruption and subsequent visceral herniation into the pleural cavity. Left-side ruptures are more common, as the right side is protected by the liver. Abdominal contents occupying the chest cavity can become ischaemic or could have been injured during the initial trauma and, additionally, might significantly compress the lung, leading to a variety of clinical presentations ranging from chest pain and peritonitis to increased rate of breathing or respiratory distress. In this video tutorial, we present a polytrauma patient after a motor vehicle collision, who sustained traumatic diaphragmatic rupture and left chest wall herniation.

Western Trauma Association critical decisions in trauma: Significant blunt cardiac injury

The Journal of Trauma: Injury, Infection, and Critical Care · 2026-02-20

The diagnosis and management of acute traumatic diaphragmatic injury: A Western Trauma Association clinical decisions algorithm

The Journal of Trauma: Injury, Infection, and Critical Care · 2025-01-28 · 7 citations

Western Trauma Association critical decisions in trauma: Penetrating thoracic injury

The Journal of Trauma: Injury, Infection, and Critical Care · 2025-12-17

Comparative Outcomes of Extremity Vascular Trauma Managed in Trauma Versus Vascular Hybrid Operating Rooms

Journal of Vascular Surgery · 2025-05-23

Early Care of Polytraumatized Patients: A Framework for Orthopaedic Surgeons

Journal of the American Academy of Orthopaedic Surgeons · 2024-12-31 · 1 citations

The role of orthopaedic surgeons during trauma activations is vague and often underused. Advanced trauma life support (ATLS) is a training program and framework for performing initial life- and limb-threatening interventions. ATLS was created by Dr. James Styner, an orthopaedic surgeon, to systematically evaluate and treat trauma patients after his family received suboptimal initial care following a plane crash in 1976. There are numerous orthopaedic assessments done during the ATLS primary and secondary surveys. Understanding hierarchy and sequencing of these interventions may enhance orthopaedic integration into the broader resuscitation and surgical efforts. ATLS training is not standard in US orthopaedic residency programs. Fundamental understanding of ventilation parameters and resuscitative protocols enhance decision making for the extent of orthopaedic surgical intervention acutely. Defining indications for emergent interventions among other surgical specialties improves multidisciplinary surgical planning. This review aims to answer the question, "What needs to be done now using the ATLS survey framework and how can an orthopaedic surgeon contribute?" Furthermore, this review intends to introduce ATLS for orthopaedic surgeons in supportive roles with surgical and nonsurgical responsibilities by describing basic protocols and evidence of benefit.

Western Trauma Association critical decisions in trauma: Damage-control resuscitation

The Journal of Trauma: Injury, Infection, and Critical Care · 2024-11-13 · 5 citations

Adult emergency resuscitative thoracotomy: A Western Trauma Association clinical decisions algorithm

The Journal of Trauma: Injury, Infection, and Critical Care · 2024-10-25 · 9 citations

Diaphragm pacing and independent breathing in individuals with severe Pompe disease

Frontiers in Rehabilitation Sciences · 2023-07-31 · 3 citations

Introduction: Pompe disease is an inherited disease characterized by a deficit in acid-α-glucosidase (GAA), an enzyme which degrades lysosomal glycogen. The phrenic-diaphragm motor system is affected preferentially, and respiratory failure often occurs despite GAA enzyme replacement therapy. We hypothesized that the continued use of diaphragm pacing (DP) might improve ventilator-dependent subjects' respiratory outcomes and increase ventilator-free time tolerance. Methods: Six patients (3 pediatric) underwent clinical DP implantation and started diaphragm conditioning, which involved progressively longer periods of daily, low intensity stimulation. Longitudinal respiratory breathing pattern, diaphragm electromyography, and pulmonary function tests were completed when possible, to assess feasibility of use, as well as diaphragm and ventilatory responses to conditioning. Results: All subjects were eventually able to undergo full-time conditioning via DP and increase their maximal tolerated time off-ventilator, when compared to pre-implant function. Over time, 3 of 6 subjects also demonstrated increased or stable minute ventilation throughout the day, without positive-pressure ventilation assistance. Discussion: Respiratory insufficiency is one of the main causes of death in patients with Pompe disease. Our results indicate that DP in Pompe disease was feasible, led to few adverse events and stabilized breathing for up to 7 years.

Operative treatment of chest wall injury

Current Therapy of Trauma and Surgical Critical Care · 2023-07-21