الفهرس 
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Abstract
Thoracic trauma is one of the leading causes of death in all age groups and accounts for 25–50% of all traumatic injuries in the world.
Penetrating cardiothoracic injuries are often fatal and a substantial number of patients is found already dead at the scene. However, if a patient arrives at a medical facility in a compensated state with intact vital signs the chance for survival is substantially increased. Knife wounds have better prognoses than those caused by firearms.
Thoracotomy allows direct visualization for all intrathoracic structures and so any injury can be managed quickly and adequately, that it will be required in approximately 30% of cases presenting after penetrating chest injury
Emergency thoracotomy is thoracotomy occurring either immediately at the site of injury, or in the emergency department or operating room as an integral part of the initial resuscitation process. Emergency thoracotomy is a lifesaving procedure, when performed with the correct indications and approaches.
This retrospective study is including 54 patients with isolated penetrating chest trauma who underwent emergency thoracotomy through the year 2011 (from the first of January 2011 till the end of December 2011) at Kasr Al-Ainy University Hospital.
The hospital records of these patients were reviewed retrospectively. Data relieved that 52 patients were males (96%) while only 2 patients were females (4%) giving a male to female ratio of 26:1. The age of the patients ranged between 17-44 years with a mean of 26 ± 6.7 years.
The most frequent patients were coming from Imbaba 9 patients (17%). Stab wound was the mechanism of trauma in 47 patients (87%) while in 7 patients (13%) due to gunshot. 49 patients (91%) due to violence assault while 5 patients (9%) were due to accidents.
Regarding the site of injury 33 patients (61%) were left side injury while 21 (39%) patients were right sided.
Most patients reached the hospital within an average time 106 ± 64.88 minutes of sustaining their injury, ranging from 30 – 300 minutes. The time elapsed to admission to the operating room was ranging from 15 – 120 minutes, mean 41 ± 33.2.
The clinical examination of our patients at admission revealed the mean of the systolic BP was 93.5 ± 18.8 mmHg ranging from 60 – 140 mmHg. A significant relationship was noticed between the mean arterial blood pressure and time to admission to the operating room (p < 0.001).
Hemoglobin level on admission was ranging from 4 – 14 with average 8.52 ± 2.5. 52. Blood transfusion was used in 96% of patients.
The main indication for thoracotomy in our patients was hemodynamic instability in 8 patients (15%), initial chest tube output > 1500cc in 30 patients (55.5%), ongoing chest tube output in 13 patients (24%) and cardiac tamponade in 3 patients (5.5%).
There is a significant relationship between the indication for thoracotomy and the time elapsed to admission to the operating room as 88% of the hemodynamic instability patients reached the operating room < 30 minutes.
The mean of total output from the chest tube before operation was 2000 ± 506 ml ranging from 1100 to 3500 ml. There was an important significant relationship between the Hb level on admission and the total chest tube output.
Regarding the surgical approaches that were done to the patients, 9 patients (17%) underwent anterolateral thoracotomy, 33 patients (61%) underwent posterolateral thoracotomy, while median sternotomy was done to 12 patients (22%). There is a significant relationship between the site of injury and surgical approach.
The thoracic injuries identified at operations were chest wall and intercostals arteries injury in 18 patients (33%), lung injuries in 37 patients (69%), cardiac injuries in 12 patients (22%), internal thoracic artery injuries in 5 patients (9%), tracheobronchial tree injury in 1 patient (2%), great vessels injury in 3 patients (6%) and diaphragmatic injury in 5 patients (9%). There is a significant relationship between the site of chest injury and thoracic injuries identified at operations.
Of the 54 cases 5 patients died intra-operatively, from the remaining 49 patients, 43 patients (88%) need post-operative ICU. Also, the need for mechanical ventilator was in 28 patients (57%)
Post-operative re-exploration was underwent in 4 patients (8%). After exclusion of death intra-operative or early in the ICU that was 10 patients, post-operative wound infection occurred in 14 patients (32%) and post-operative chest infection occurred in 10 patients (23%).
The mean of the total hospital stay for discharged patients was 6 ± 2.44 day, ranging from 3 – 14 day.
On trying to study variables affecting mortality, we found that mortality was significantly associated with stab wounds, lift side chest injury, medial to MCL chest injury, mean arterial BP < 70 mmHg on admission, Hb < 9g/dl on admission, total chest tube output before thoracotomy ≥ 2000, presence of cardiac injury and presence of great vessels injury.
The overall mortality in our study was 13 (24%) of the 54 patients. The mortality in patients with cardiac and great vessels injury was (64%), while the mortality in patients with chest wall, diaphragm and lung injury was (10%)