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Thoracic Damage Control: Let’s Think About Intrathoracic Packing

Maud Prezman-Pietri, Pierre Rabinel, Grégoire Périé, Bernard Georges, Laurent Brouchet, Fanny Vardon Bounes

(Anesthesiology and Critical Care Unit, University Teaching Hospital of Toulouse, Toulouse, France)

Am J Case Rep 2018; 19:1526-1529

DOI: 10.12659/AJCR.911097

BACKGROUND: In cases of hemorrhagic shock following thoracic trauma, thoracotomy is indicated as primary surgical management, as a chest tube might lead to exsanguination. Thoracic packing is an alternative, particularly in severe injury trauma.
CASE REPORT: A 48-year-old male was involved in an accident in which 2 cars collided. The patient suffered from right-sided hemothorax due to diaphragm rupture and stripping of the diaphragmatic pillar. A right anterolateral thoracotomy revealed an active bleed due to diaphragmatic pillar stripping and laceration with liver herniation. Right thoracic packing was established to stop the bleeding.
CONCLUSIONS: The primary objectives of thoracic damage control are to prevent cardiac tamponade, to control intrathoracic bleeding and massive air embolism or bronchopleural fistula, and to allow open cardiac massage. These patients represent challenging cases of both rapid therapeutic decision-making and operative intervention. Thoracic packing is a part of damage control in cases of hemorrhagic shock after thoracic trauma.

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