Emergency surgery for major pulmonary injury

Abstract

Severely shocked patients with thoracic injury often require emergency thoracotomy before a definite diagnosis can be made. A method of management of pulmonary injury is described by performing exploratory resuscitative anterolateral thoracotomy which can be extended across the sternum to the opposite side, if necessary. Control of haemorrhage from the lung is achieved by mass clamping of the hilum and waiting for further resuscitation. After adequate resuscitation, specific management of the lung injury is performed as indicated. This approach was used in 26 cases of life-threatening pulmonary injury. Exposure of the injured lung was good in all cases. Pneumonography was performed in 8, segmental resection in 8 and pneumonectomy in 5 cases. Surgery and resuscitation were abandoned in 5 unsalvageable cases. Eleven patients (42%) survived. All general and trauma surgeons should be able to perform emergency thoracotomy for trauma. The method described here is simple, needs no special equipment and is suitable for most instances.