Emergency thoracoscopy: a logical approach to XXXX management.

@entity1 @entity190 @entity3509 @entity764 @entity4461
Expeditious surgical management in serious @entity764 improves survival rates. However, guidelines for emergency thoracotomy that depend on the initial amount of @entity190 or continuing @entity190 are imprecise and frequently require a period of observation. In an attempt to improve prethoracotomy diagnosis emergency thoracoscopy was used in the operating room in 36 @entity1 who presented with hemothoraces. A diagnostic thoracoscope was inserted through the previously placed incisions for chest tubes. The procedure was well tolerated under local anesthesia and in most @entity1 took less than 15 minutes to complete. No complications resulted from thoracoscopy. When the information obtained did not indicate further operations, the thoracoscope was withdrawn and chest tubes were reinserted through the same incisions. The method provided anatomic definition of the injuries in 35 of 36 @entity1 and allowed the determination of whether @entity190 was continuing. Management was altered as a result of thoracoscopy in 16 @entity1 (44.4%). An unnecessary thoracotomy was avoided in 16 @entity1 who had greater than 1,500 ml of blood in the thoracic cavity on admission and allowed a more rapid thoracotomy in one @entity1 . Four @entity1 had wounds located close to the diaphragm and laparotomy was avoided when the diaphragm was found free of injury. Bleeding from lacerated intercostal vessels was stopped with diathermy during thoracoscopy in two of three @entity1 . In addition, 15 @entity1 had 200 ml or more of clotted blood removed. The usefulness of @entity4461 remains to be proved but it is hoped that the incidence of @entity3509 will be reduced. Emergency thoracoscopy has proved a valuable diagnostic and therapeutic measure in @entity1 sustaining penetrating @entity764 .
