Abstract
Chest injuries account for a quarter of all trauma deaths, usually from rupture of the thoracic aorta. On presentation to hospital, life-threatening chest injuries that require immediate identification and management include tension pneumothorax, open pneumothorax, massive haemothorax and pericardial tamponade. Most chest injuries can be managed with simple measures including intercostal tube insertion, oxygen therapy, analgesia and mechanical ventilation. Urgent thoracotomy is indicated for pericardial tamponade, diaphragmatic rupture and massive haemothorax with ongoing bleeding. Emergency thoracotomy is indicated after penetrating chest trauma with witnessed loss of vital signs. Significant blunt aortic injury requires good blood pressure control and endovascular or operative repair. Tracheobronchial and oesophageal injuries are uncommon, but require prompt treatment to avoid significant morbidity. Delayed identification of injuries and severe chest wall injuries may require prolonged intensive care stay.
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