Thoracic injury requiring surgery.

Abstract

AbstractThis report concentrates on the 15% of chest injuries requiring thoracotomy. Eighty‐five percent of cases may be managed by a large‐bore chest tube placed in the midaxillary line. The indications for thoracotomy following placement of a chest tube are immediate egress of 1,500 ml of blood, continued bleeding at a rate of more than 100 ml/h, and large air leaks that prevent re‐expansion of the lung or that, on the ventilator, constitute a significant fraction of the tidal volume. Immediate thoracotomy is also indicated for the patient with a penetrating wound that may have reached the heart in association with acute loss of vital signs or shock that does not quickly respond to blood replacement. Emergency room thoracotomy may also allow salvage of blunt trauma patients with blood loss in the chest by allowing more effective control of blood loss, cardiac massage, and cross‐clamping of the aorta. A persistent diagnostic suspicion of the hidden injuries such as aortic rupture, esophageal injury, airway rupture, blunt cardiac injuries, and diaphragmatic rupture must be maintained, so that these injuries are properly diagnosed and treated. Sepsis following trauma to the chest is generally related to retained hematoma and damaged tissue. It is probably wise to resect the pulmonary parenchyma damaged by a high velocity gunshot wound. Chest tubes for hemothorax should be placed so that the blood is totally evacuated; otherwise, the clotted blood usually restricts pulmonary ventilation and commonly leads to an empyema which requires surgery.