Mai Juliana Ying Liang, Holmes Andrew, Frahm-Jensen Gert
Trauma Service and General Surgery, The Canberra Hospital, Garran ACT, Australia.
Vascular Surgery, The Canberra Hospital, Garran ACT, Australia.
Trauma Case Rep. 2020 Jun 29;29:100333. doi: 10.1016/j.tcr.2020.100333. eCollection 2020 Oct.
Advanced Trauma Life Support principles prioritise the management of 'breathing' over 'circulation' in an acute trauma primary survey. In a tamponaded thoracic aortic rupture, however, this may lead to fatal haemorrhagic shock. In this case, we discuss the resuscitation and management of a patient with a massive left sided haemothorax secondary to a grade four blunt traumatic aortic injury. A 26-year-old male was involved in a high-speed motor vehicle crash and was hypoxic and hypotensive at the scene. His oxygenation and haemodynamics improved with supplemental oxygen and fluid resuscitation. He had a left intercostal catheter inserted after an urgent thoracic endovascular aortic repair was performed to prevent disruption of the contained haemothorax in the presence of a grade four thoracic aortic injury. It is vital to recognise the potential disruption of a tamponaded blunt traumatic aortic injury during consideration of thoracostomy and chest drain decompression.
在急性创伤初级评估中，高级创伤生命支持原则将“呼吸”管理置于“循环”管理之上。然而，在填塞性胸主动脉破裂的情况下，这可能导致致命的失血性休克。在此病例中，我们讨论了一名因四级钝性创伤性主动脉损伤继发大量左侧血胸患者的复苏及管理情况。一名26岁男性遭遇高速机动车碰撞，在现场时出现缺氧和低血压。经补充氧气和液体复苏后，其氧合及血流动力学状况有所改善。在进行紧急胸主动脉腔内修复术后，为防止在存在四级胸主动脉损伤的情况下所包含的血胸破裂，为他插入了左侧肋间导管。在考虑进行胸廓切开术和胸腔引流减压时，认识到填塞性钝性创伤性主动脉损伤的潜在破裂情况至关重要。
