Lee Chang-Sin, Cho Min-Jeong, Noh Tae-Wook, Choi Nak-Jun, Cho Jun-Min
Department of Acute Care Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
J Trauma Inj. 2024 Jun;37(2):147-150. doi: 10.20408/jti.2023.0066. Epub 2024 Feb 23.
This case report describes the management of a 51-year-old female patient who arrived at the emergency room with a stab wound to the upper right chest. Immediate medical interventions were undertaken, including blood transfusions and endotracheal intubation. To prevent tension and control bleeding, gauze packing was applied directly through the large open wound. Further surgical exploration identified a laceration in the lung, necessitating a right upper lobe resection. Postoperatively, the patient's vital signs stabilized, and she was subsequently discharged without complications. This case highlights the decision-making process in selecting between an emergency department thoracotomy and an operating room thoracotomy for patients with penetrating chest trauma. It also illustrates the role of gauze packing in managing tension and hemorrhage. In summary, gauze packing can be an effective interim measure for stabilizing patients with traumatic injuries, unstable vital signs, and large open chest wounds, particularly when a chest tube is already in place, to prevent tension and facilitate bleeding control prior to surgical intervention.
本病例报告描述了一名51岁女性患者的治疗情况,该患者因右上胸部刺伤被送至急诊室。立即采取了医疗干预措施,包括输血和气管插管。为防止张力形成并控制出血,通过大的开放性伤口直接进行了纱布填塞。进一步的手术探查发现肺部有一处裂伤,需要进行右上叶切除。术后,患者生命体征稳定,随后顺利出院,无并发症。本病例突出了在为穿透性胸部创伤患者选择急诊开胸手术和手术室开胸手术之间的决策过程。它还说明了纱布填塞在处理张力和出血方面的作用。总之,纱布填塞对于稳定创伤性损伤、生命体征不稳定且有大的开放性胸部伤口的患者可能是一种有效的临时措施,特别是在已经放置胸管的情况下,可防止张力形成并便于在手术干预前控制出血。