Approximately 60% of all multi system trauma victims have some type of chest
or thoracic trauma. Chest trauma is classified as either BLUNT or
PENETRATING
2/3 of deaths occur after reaching hospital
Serious pathological consequnces:
-hypoxia, hypovolaemia, myocardial failure
2. Penetrating trauma occurs when a foreign object penetrates the chest wall. Gun
shot wound and Stabbing are the most common causes
RIB FRACTURES
Injury at the first 3 ribs though rare but result in high mortality rate
5th -9th rib common site of fracture
2. Flail Chest,
Multiple rib fractures produce a mobile fragment which moves
paradoxically with respiration
3. Pulmonary Contusion.
Damage to the lung tissues resulting in hemorrhage and localized edema.
Observed in about 20% of adult patients with multiple traumatic injuries
and in higher percentage of children due to increased compliance of the
chest wall.
PENETRATING TRAUMA :
1. STAB WOUNDS, are generally considered of low velocity because the weapon
destroys a small areaaround the wound. Knives and switchblades cause most stab
wounds. Appearance of the external wound may be very deceptive, because
pneumothorax, hemothorax, lung contusion, and cardiac tamponade, along with
severe and continuing hemorrage.
Diagnostic Tests
Chest X-ray, Chemistry profile, arterial blood gas analysis, pulse oximetry, and
ECG.
Blood typing and cross matching are done in case blood transfusion is required.
Management
Immediate management is to restore and maintain cardiopulmonary function.
A chest tube is inserted into the pleural space in most patients with penetrating
wounds of the chest to achieve rapid and continuing re-expansion of the lungs,
results in a complete evacuation of the blood and air.
* If the patient has penetrating wound of the heart and great vessels, the esophagus, or the
tracheobronchial tree, surgical intervention is required.