Thoracic Trauma

Fritz J. Baumgartner

The management of thoracic trauma is a complex field not only because of the major anatomic structures running through the chest, but also because management of thoracic trauma must be integrated with management of concomitant abdominal trauma, neurologic trauma and orthopedic trauma. Ignoring any of these aspects may be life-threatening for the patient.

The immediately life-threatening chest injuries that need to be identified by the physician in the initial assessment includes the following:

1) Airway obstruction

2) Tension pneumothorax

3) Open pneumothorax (i.e. sucking chest wound)

4) Massive hemothorax

5) Flail chest

6) Cardiac tampanode

During the secondary survey, the identification and treatment of other life-threatening injuries can be achieved. These include:

1) aortic disruption;

2) pulmonary contusion;

3) tracheobronchial rupture;

4) myocardial contusion;

5) esophageal rupture;

6) traumatic rupture of the diaphragm.

Most injuries to the chest, both blunt and penetrating, do not require surgery. Only about 10% of chest injuries actually require operative management. Hy-poxia is the most immediately threatening feature of chest injury and interventions directed towards managing chest trauma must insure adequate ventilation and oxygenation of the body.

The primary survey of life-threatening chest trauma includes an assessment of the adequacy of the ventilation, and if this is inadequate the patient should be intubated and ventilated with 100% oxygen. Large bore IV's are established in each antecubital fossa and simultaneously blood drawn for type and cross match and routine lab work. Primary survey evaluating the patient's overall head, chest, abdominal and extremity status is performed. The specific management of the immediately life-threatening chest injury identified in the primary survey will now be discussed.

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