A rare case of Double Superior Vena Cava, diagnosed after Central Line placement, in a poly-trauma patient

Health professionals involved in invasive procedures such as central venous catheter placement should have a thorough knowledge of thoracic vascular anatomy. Various developmental anomalies of the large intra-thoracic veins can be incidentally discovered in normal adults. Amongst these congenital anomalies is a duplication of superior vena cava (SVC), which results from failure of the left superior cardinal vein to obliterate. Awareness about this anomaly and its variations is important to help overcome challenges in procedures, as well as avoid complications. In this article, we present a case of incidentally diagnosed double-SVC in an adult polytrauma patient after central line insertion in the Trauma Intensive care Unit.qscienc

Absence of an elective on-site neurological service : impact on outcomes in severely injured head trauma patients in a tertiary referral trauma center

A retrospective study was conducted to compare two groups of patients treated at the Montreal General Hospital (MGH) for traumatic brain injuries (TBI). The time to neurosurgery, vital status and length of stay in the ICU was evaluated in 299 patients treated before (1997-1998), and 307 patients after (2000-2001) an elective neurosurgery service was eliminated from the NIGH. The outcomes were not significantly different between the two groups. There were trends towards a shorter time to neurosurgery in the group treated in 2000-2001 (4.5 hours) compared to the group treated in 1997-1998 (5.5 hours; p=0.32). Mortality and length of stay in the ICU did not significantly differ between the two groups. This study suggests the provision of adequate neurotrauma care with respect to acute outcomes in the absence of an on-site neurosurgery service, at our institution

Traumatic lung laceration secondary to avulsed lung adhesion - A case report

Background: Pulmonary lacerations caused by an avulsion force on an adhesion between the lung and chest wall following blunt thoracic injury are very rare. They may result in pneumothorax and/or hemothorax and may not be immediately apparent clinically or radiologically. Case presentation: We present the case of a healthy 34-year-old male who sustained blunt thoracic injury. He was clinically stable, and his initial routine images were unremarkable. The patient was discharged home on the same day. He presented a week later with a massive hemothorax requiring surgical intervention which revealed bleeding from an avulsed adhesion between the lung and chest wall. Bleeding was successfully controlled by hemostatic agent, and the patient had an uneventful recovery. Conclusion: Hemothorax requiring intervention from an avulsed adhesion may occur following blunt thoracic trauma. Initial imaging and clinical finding may be misleading. Close follow up and adequate patient education should be ensured prior to discharge following seemingly trivial trauma

An expanding role for cardiopulmonary bypass in trauma

OBJECTIVES: To analyze experience at the McGill University Health Centre with cardiopulmonary bypass (CPB) in trauma, complemented by a review of the literature to define its role globally and outline indications for its expanded use in trauma management. DATA SOURCES: All available published English-language articles from peer reviewed journals, located using the MEDLINE database. Chapters from relevant, current textbooks were also utilized. STUDY SELECTION: Nine relevant case reports, original articles or reviews pertaining to the use of CPB in trauma. DATA EXTRACTION: Original data as well as authors' opinions pertinent to the application of CPB to trauma were extracted, incorporated and appropriately referenced in our review. DATA SYNTHESIS: Overall mortality in the selected series of CPB used in the trauma setting was 44.4%. Four of 5 survivors had CPB instituted early (first procedure in operative management) whereas 3 of 4 deaths involved late institution of CPB. CONCLUSIONS: Although CPB has traditionally been used in the setting of cardiac trauma alone, a better understanding of its potential benefit in noncardiac injuries will likely make for improved outcomes in the increasingly diverse number of severely injured patients seen in trauma centres today. Further studies by other trauma centres will allow for standardized indications for the use of CPB in trauma