Blunt injuries of the chest

Abstract

Blunt chest injuries are the most common form of thoracic trauma. Pulmonary and myocardial contusions are almost universal to some degree in major chest trauma and are usually managed non-surgically as are injuries to the chest wall. Pneumothorax and haemothorax require pleural drainage, and only rarely need an open thoracotomy for repair of the underlying injury. The majority of patients suffering from a significant major vessel, major airway and cardiac injury will die immediately. In those surviving to hospital their underlying condition may not be easy to diagnose, but prompt recognition and surgical treatment can be lifesaving. Awareness of the spectrum of important injuries and careful inspection of the initial chest radiograph supplemented by CT scanning allows most problems to be investigated appropriately and eventually diagnosed with confidence. Alterations to the usual ATLS management pathway may be necessary to ensure that the interventions normally used to resuscitate patients do not make their condition worse, e.g. endotracheal intubation for major airway trauma, excessive volume transfusion for cardiac tamponade. Patients suffering from blunt chest trauma usually have associated injuries in other parts of the body, especially with the abdomen so in those patients going to theatre for a thoracotomy, a laporotomy also should be seriously considered as an additional procedure.