Double jeopardy revisited: clinical decision making in unstable patients with, thoraco-abdominal stab wounds and, potential injuries in multiple body cavities

Injury
D L ClarkeSandie Rutherford Thomson

Abstract

In the setting of the hypovolaemic patient with a thoraco-abdominal stab wound and potential injuries in both the chest and abdomen, deciding which cavity to explore first may be difficult.Opening the incorrect body cavity can delay control of tamponade or haemorrhage and exacerbate hypothermia and fluid shifts. This situation has been described as one of double jeopardy. All stab victims from July 2007 to July 2009 requiring a thoracotomy and laparotomy at the same operation were identified from a database. Demographics, site and nature of injuries, admission observations and investigations as well as operative sequence were recorded. Correct sequencing was defined as first opening the cavity with most lethal injury. Incorrect sequencing was defined as opening a cavity and finding either no injury or an injury of less severity than a simultaneous injury in the unopened cavity. The primary outcome was survival or death. Sixteen stab victims underwent thoracotomy and laparotomy during the same operation. All were male with an age range of 18–40 (mean/median 27). Median systolic blood pressure on presentation was 90 mm Hg. (quartile range 80–90 mm Hg). Median base excess was 6.5 (quartile range 12 to 2.2). All the deaths were the...Continue Reading

References

Nov 1, 1991·American Journal of Surgery·D J Muckart, S R Thomson
Nov 1, 1986·The British Journal of Surgery·D DemetriadesN Markides
Oct 1, 1984·Thorax·D J MuckartL W Baker
May 29, 1998·The Surgical Clinics of North America·G S RozyckiT P Davis
Jul 5, 2002·World Journal of Surgery·Juan A AsensioDemetrios Demetriades
Mar 13, 2008·World Journal of Surgery·D L ClarkeD J J Muckart

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Citations

Jan 25, 2014·The Journal of Trauma and Acute Care Surgery·Regan J BergDemetrios Demetriades
Dec 11, 2014·The Journal of Trauma and Acute Care Surgery·Regan J BergDemetrios Demetriades
Sep 29, 2011·Injury·Nishant BediMichael Walsh
Dec 3, 2014·The Journal of Surgical Research·Victor Y KongDamian L Clarke
Aug 6, 2017·World Journal of Surgery·Kazuhide MatsushimaDemetrios Demetriades
Aug 13, 2015·Annals of the Royal College of Surgeons of England·V Y KongD L Clarke
Jun 6, 2019·BMJ Case Reports·Muhammad Zafar KhanRigo Hoencamp

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