Recommended Citation
Rashid M, Saatee S. Perioperative management of life-threatening penetrating thoracic trauma. Presented at: Midwest Anesthesia Residents Conference; April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference; April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Thoracic trauma is a significant contributor to trauma-related mortality, accounting for approximately 25% of traumatic deaths in the United States[1,2]. The mechanisms of thoracic trauma are broadly categorized into penetrating and blunt injuries, each with distinct causes and clinical implications [2]. Case Presentation: This case involves a 22-year-old male who presented to the trauma bay after sustaining multiple gunshot wounds to the bilateral chest, epigastric region, and right arm. Upon initial assessment, the patient had a Glasgow Coma Scale (GCS) score of 13 and was hemodynamically stable. He had multiple bullet entry wounds to the chest, abdomen, and right arm. However, he rapidly deteriorated, with his GCS dropping to 7 and oxygen saturation (SpO₂) falling to 70–80% despite receiving 15 L of oxygen. The patient was promptly intubated, and imaging revealed a moderate-to-large hemopneumothorax, for which bilateral chest tubes were placed. Additional findings included a Grade 4 splenic injury, Grade 2 hepatic injury, and a perforated gastric injury at the greater curvature. The patient was emergently transferred to the operating room. Upon arrival, an invasive arterial line was placed. During the surgery, he became hypotensive (MAP 45–60 mmHg) and desaturated (SpO₂ 50–60%), requiring massive transfusion protocol activation and vasopressors. Bronchoscopy identified massive airway hemorrhage, necessitating repeated suctioning (1.2 L blood removed). Cardiothoracic surgery was consulted, and resuscitation included 12 units PRBCs, 10 units FFP, and 10 units platelets. Surgical intervention included splenectomy, gastric resection, hepatorrhaphy, diaphragmatic repair, thoracotomy, and limb debridement, with continued airway management. Postoperatively, he required ICU-level care, frequent airway suctioning, and inhaled nitric oxide for ARDS. A second-look laparotomy with diaphragmatic hernia repair and abdominal closure was performed on day 2. By postoperative day 6, he was extubated (GCS 15), tolerated oral intake, and made a full recovery, ultimately discharged on day 18. Conclusion: This case highlights the importance of aggressive, multidisciplinary trauma care. Early bronchoscopy played a crucial role in airway management and pulmonary hemorrhage control, suggesting its potential benefit in penetrating thoracic trauma. 1. Lundin, A., et al. (2022) Scand J Trauma Resusc Emerg Med 30:69. 2. Aydin NB, et al. et al. (2008) Moon MC, Gill I. Cardiac and great vessel trauma. In: Smith CE, ed. Trauma Anesthesia. New York, NY: Cambridge University Press; 260–278.
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center