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Related Experiment Videos

Transmediastinal gunshot wounds: a prospective study.

B M Renz1, R A Cava, D V Feliciano

  • 1Gwinnett Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA.

The Journal of Trauma
|April 1, 2000
PubMed
Summary

Systolic blood pressure (SBP) in the emergency center helps triage patients with transmediastinal gunshot wounds (TM-GSWs). Patients with SBP < 60 mm Hg require immediate operation, while those with SBP > 100 mm Hg may undergo further evaluation.

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Cardiovascular Physiology

Background:

  • Transmediastinal gunshot wounds (TM-GSWs) present complex triage challenges.
  • Effective triage protocols are crucial for optimizing outcomes in trauma patients.

Purpose of the Study:

  • To assess the utility of admission systolic blood pressure (SBP) in the emergency center (EC) for triaging patients with TM-GSWs.
  • To differentiate between patients requiring immediate surgery and those suitable for further diagnostic evaluation.

Main Methods:

  • A prospective case series of 68 consecutive patients with TM-GSWs.
  • Patients were grouped based on EC SBP: Group I (>100 mm Hg), Group II (60-100 mm Hg), and Group III (<60 mm Hg).
  • Management and outcomes were analyzed for each group.

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Main Results:

  • In Group I (n=20), 75% diagnosed by x-ray, 20% by exam; 25% required immediate operation.
  • In Group II (n=16), 56% diagnosed by x-ray, 31% by exam; 37.5% required operation after resuscitation/evaluation.
  • In Group III (n=32), 100% mortality in those undergoing EC thoracotomy or pronounced dead without operation.

Conclusions:

  • Admission SBP is a valuable triage tool for TM-GSW patients.
  • Patients with SBP > 100 mm Hg can often undergo further diagnostic evaluation if hemodynamically stable.
  • All patients with SBP < 60 mm Hg require immediate operative intervention.