The management of chest trauma

Abstract

Severe chest trauma is associated with a significant mortality, several recent studies quoting figures of 15 - 25%.l** The principal cause in western society is road traffic accidents, but penetrating wounds associated with gun shots or stabbing, are not infrequent depending on the locality. Similar consideration applies to bomb blast injuries. Of major importance in determining the outcome is the presence of associated injuries, which often dictate a change in treatment protocols. The combination of a severe head injury with major thoracic trauma is particularly grave3 being responsible for 50% of the deaths in those with chest injuries. Johnson et a1.4 identified four positive factors for death from chest trauma; injury severity score >25; Glasgow Coma Scale ~7; transfusion of >3 units of blood; p02/Fi02 ratio <300. These four factors plus the presence of shock and a concomitant flail segment were accurate predictors of the need for mechanical ventilation. What is not in doubt is the poor outcome in severe chest trauma, a factor which has not changed appreciably in the past 25 years despite major changes in treatment modalities. This article discusses the emergency treatment of chest trauma with reference to resuscitation and the diagnosis of associated injuries. Further treatment both conservative and more radical is considered and guidelines offered for choosing the therapy appropriate to a given patient.