Introduction: Traumatic abdominal wall hernias (TAWH) are caused by the rupture of the muscle and fascial structures after high-energy blunt trauma, most of them with the integrity of the skin. Due to the rarity of its presentation, clinical diagnosis is generally infrequent, and treatment is controversial. We describe our experience with these hernias and their associated injuries, making special mention of a case of complete disruption of the abdominal wall. Materials and methods: Descriptive and retrospective study of the severe trauma registry at our trauma reference center in Madrid. Patients diagnosed with TAWH were studied over a 20-year period (2001–2020), analyzing demographic data, injury mechanisms, type and location of TAWH, associated injuries, and treatment. Results: During the study period, 692 patients with severe blunt abdominal trauma were registered. Six patients with TAWH were identified, aged between 20 and 64 years. The mechanism of injury was traffic collision, except for one bullhorn trauma. The diagnosis was established in three patients during clinical evaluation, in two by computed tomography (CT) scan, and the other during surgery. The TAWH were located mainly in the anterior wall (five cases), and one in the lumbar region. Five had associated intra-abdominal injuries, and two had bone fractures. There was a belt sign in two patients. Four patients required urgent surgery within the first 24 hours, with primary closure of the defect in two of them, and wall reconstruction with mesh in the others. No mortality was recorded, and an early hernia recurrence was observed in one patient. Conclusion: Traumatic abdominal wall hernia is a very rare injury that occurs in blunt trauma cases. Although they may be suspected in the clinical evaluation, confirmation is made by CT scan. It is important to individualize management and assess the risk-benefit balance of urgent or delayed wall reconstructions based on the associated injuries and the patient's clinical status. Clinical significance: The low incidence of TAWH leads to controversy in its management, with supporters for both urgent and deferred repair.

Mechanical ventilation (MV) is not free of complications; therefore, patients must be weaned off whenever possible. This study aimed to characterize the MV weaning process in an intensive care unit (ICU) in Latin America. Materials and methods: A transversal, analytic, single-center, descriptive study was conducted over 4 months, in mechanically ventilated patients who were eventually extubated. The primary outcome was to determine extubation failure (EF) after MV cessation, with any of the following extubation methods: after spontaneous breathing trial (SBT) performance, planned extubation without SBT, fortuitous extubation, or tracheostomy. Secondary outcomes included the exploration of the effects of extubation methods on days of MV, in-hospital mortality, ventilator-associated pneumonia (VAP), and number of intubations. Results: Data from 52 patients were collected. The median age was 41 years, 48% being women. Most patients were on MV due to respiratory conditions (22, 42.3%). MV median time was 3 days [interquartile range (IQR) 2.0–7.2], p = 0.8. The most common method for MV withdrawing was planned extubation, n = 32 (61%). Approximately, 40% of patients died, and performing SBT did not reduce the risk of EF, nor in-hospital mortality risk [odds ratio (OR) 0.41, 0.18–1.60, 95%, confidence interval (CI) p = 0.224]. Similarly, no difference was found in VAP occurrence according to the extubation method (p > 0.9). However, a trend for reduced mortality was observed in patients with two intubations and SBT (OR 7.13, 1.15–73.79, 95%, CI p = 0.053). Conclusion: No significant differences were observed in relationship to days on MV, VAP, or in-hospital mortality whether extubation was preceded by SBT or not. Further research is warranted to explore the factors influencing the weaning process and to validate the findings in larger and more diverse patient populations.

Introduction: The “trauma tele-grand rounds” (TTGR) in telemedicine format enables international institutions to meet and debate the treatment of patients in critical condition. This useful tool not only fills in training gaps but also provides ongoing medical updates and exposure to various approaches to treating patients with multiple traumas. This study's goal was to describe the role of the university hospital in supporting the conferences and its characteristics during TTGR. Methods: Retrospective evaluation of trauma videoconference records hosted by the Panamerican Trauma Society (PTS) with global participation in English, and by the Brazilian Trauma Society (SBAIT) and Division of Trauma Surgery (DCT) of Unicamp, with national participation in Portuguese. All conferences were free and were analyzed in the pre-COVID-19 pandemic period (2011–2019), evaluating the topics covered, the interactivity of trauma centers, and participants. Results: Over the 9-year study period, 362 meetings involving 92 different institutions from all five continents occurred and were reviewed. Around 26 TTGR (6.8%) focused on nontraumatic acute care cases were excluded. The remaining 336 (93.2%) TTGR focused on trauma, mostly penetrating or blunt trauma. Of the 336 meetings, 240 were promoted by PTS (in English), 58 by SBAIT, and 41 by DCT, including 11 evidence-based telemedicine–trauma and acute care surgery (EBT-TACS). In addition to the presentation of uncommon cases, the TTGR allowed for constructive disagreements, educational opportunities, and lessons learned related to current natural disasters, mass casualties, and challenging decision-making in real-life situations. The university hospital conference room received a total of 818 participants, mainly medical students (93.8%), surgery residents (2.8%), and assistants (3.4%). Conclusion: In conclusion, our review indicates that TTGRs can attract students and residents to discuss trauma. This educational tool offers diverse lessons learned during discussions about challenging real-life cases led by experienced professionals. This experience promoted international information exchange and increased the motivation for discussing trauma cases and using the telemedicine room. The participation of different trauma centers allowed the acquisition of a robust technical repertoire that can be adapted to the reality of the participants, filling gaps in medical education and training participants to offer better care to trauma patients.

Aim and background: Vascular injuries are among the leading causes of exsanguination in trauma patients. However, complex surgical procedures are not appropriate for patients in critical physiological conditions. This paper aims to present practical suggestions for these situations through a review of how to improvise temporary vascular shunts (TVSs), suggestions on which vessels can be ligated, when to perform fasciotomies, and when to indicate primary amputation. Methods: A narrative review of the literature was performed, and authors’ case images were employed to illustrate practical aspects regarding vascular damage control in limited resource environments. Results: Paramount tools for temporary hemostasis include the use of tourniquets for compressible vascular injuries, balloons for junctional injuries, and resuscitative endovascular balloon occlusion of the aorta (REBOA) for noncompressible trauma, while vascular shunts are the cornerstone for the urgent restoration of blood flow. Conclusion: Regarding vascular trauma, “damage control” surgery refers to obtaining expeditious bleeding control and restoring organ/limb perfusion while avoiding time-consuming surgical techniques. Clinical significance: When damage control in vascular trauma is required in environments with limited resources, such as geographically isolated locations or the battlefield in war zones, difficulties are often enhanced by the unavailability of devices, instruments, and surgical expertise in treating these potentially lethal injuries. This paper presents practical suggestions for these situations.

Aim: To report a case of coronary artery perforation (CAP) with cardiac tamponade, treated by a trauma surgeon in a hospital without an extracorporeal circulation device. Background: Percutaneous coronary interventions (PCIs) are ordinarily performed worldwide. One rare complication is vessel perforation, occurring in approximately 0.1–0.5% of all interventions. Most descriptions are reported in facilities with access to extracorporeal circulation. Case description: A 51-year-old man underwent an angioplasty with stent placement in the right proximal coronary artery. At the end of the procedure, a leak in the vessel was identified, with contrast extravasating into the pericardial space. The patient began to complain of progressing dyspnea and presented with cold extremities, jugular venous distension, and tachycardia. Immediately after the leak was identified, his blood pressure was 130/80 mm Hg, which fell to 88/60 mm Hg 15 minutes later. Point-of-care ultrasonography confirmed the pericardial effusion, and it was decided to approach the pericardium through a left anterolateral thoracotomy. The coronary artery showed no active bleeding, all blood was evacuated, and the pleural cavity was drained. On the 3rd postoperative day, pneumonia was identified, which was treated without complications. He was discharged on the 5th postoperative day. On the 40th postoperative day, he had no complaints, and his echocardiography revealed no abnormalities related to the procedure. Conclusion: The diagnosis and treatment of CAP with cardiac tamponade must be swift. The surgical approach initially aims to alleviate the tamponade; subsequently, the situation must be evaluated regarding the necessity to address the perforated vessel. Clinical significance: Cardiac trauma is a rare event, and coronary artery trauma is even rarer. Iatrogenic cardiac trauma is increasing due to percutaneous intervention. In the absence of an extracorporeal circulation device, the trauma surgeon must choose a surgical approach that allows for the alleviation of tamponade, is swift, and provides access to the potential bleeding site. Rapid and assertive decisions are more complex than the surgical technique itself.

The erector spinae block can be injected once or continuously using a catheter. The procedure is quite simple to carry out in the preoperative area, and it can be done with little to no sedation. One of the most painful surgical operations is a thoracotomy, and all anesthesiologists must provide appropriate analgesia. Ineffective pain management hampers deep breathing, coughing, and remobilization, leading to atelectasis. First-line treatments for pain after thoracotomy include thoracic paravertebral block (TPVB) and thoracic epidural analgesia (TEA). However, implementing TEA is difficult and has a high failure rate. We used the simple tool visual analog scale (VAS) scores to assess the quality of the block, which were assessed and maintained for 24 hours. We are happy to announce that the single-shot erector spinae plane (ESP) block guided by ultrasound effectively relieved pain after thoracotomy surgery while also reducing the amount of narcotics used.

Aim and background: Pericardial rupture with cardiac herniation following blunt trauma is an exceedingly rare and often fatal condition, typically resulting from high-energy deceleration forces. With an occurrence rate of 0.37% in blunt trauma cases and a mortality rate of 36.4–42.9%, prompt diagnosis and surgical management pose significant challenges (Fulda et al., 1990; Sohn et al., 2005; Guenther et al., 2020). This case report documents a novel use of cardiac-gated computed tomography (CT) to assist in the rapid diagnosis of this condition. Case description: A 30-year-old woman presented to a local hospital following an eight-story fall with multiple injuries. After treating initial life-threatening conditions, X-ray imaging showed a mediastinal shift and an abnormal cardiac silhouette. The patient was transferred to a Level I trauma center for further management. Shortly after arrival, an electrocardiogram (ECG)-gated cardiac CT scan revealed a blunt traumatic pericardial rupture (BTPR) with atrial herniation. After addressing other life-threatening injuries, a sternotomy and pericardial exploration were performed, revealing a large tear on the right side of the pericardium with right atrial displacement. The pericardial defect was large and, therefore, not repaired as it was deemed to be low risk for strangulation. Conclusion: Blunt traumatic pericardial rupture with cardiac herniation is a rare and potentially fatal condition that requires a high index of suspicion and prompt management. Advanced imaging techniques, such as ECG-gated cardiac CT angiography and transesophageal echocardiography, play a crucial role in diagnosis and surgical planning. Treatment should prioritize life-threatening injuries and consider the size and location of the pericardial rupture. Clinical significance: This case highlights the importance of increased awareness and vigilance among healthcare providers when managing patients with severe blunt chest trauma. Increased awareness of this rare injury pattern among providers and the utilization of advanced imaging modalities can lead to timely diagnosis and appropriate surgical intervention, ultimately improving patient survival in cases of BTPR with cardiac herniation.