Pulmonary laceration and contusion in a young male patient due to a motorcycle accident

Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries. Pulmonary contusions are the most common identified entities after trauma, and they result in alveolar hemorrhage without loss of the physiological structure of lung parenchyma. On the other hand, pulmonary lacerations, which are often associated with contusions, result in rupture of the alveoli causing formation of cavities. Patients present symptoms ranging from minimal to severe, including cough, chest pain, hemoptysis, dyspnea, tachypnea, and hypoxemia. Findings may not be apparent immediately after injury and chest CT is the most sensitive imaging technique for diagnosis. Contusions usually resolve with supportive care in 5–7 days. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. © 2021 Apollonatou V. et al

Intraoperative transfusion practices in Europe

BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. CLINICAL TRIAL REGISTRATION: NCT 01604083