Practice ABC of Major Trauma, 4th Edition

Thoracic Trauma

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1137 (Published 07 March 2014) Cite this as: BMJ 2014;348:bmj.g1137
  1. Andrew Blyth
  1. Royal Berkshire Hospital Reading, UK

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Overview

Thoracic trauma leads to:

  • respiratory and cardiovascular inplications

  • hypoxia

  • hypovolaemia

  • reduced cardiac output.

Untreated, it will be fatal.

Trauma in the United Kingdom annually results in 720,000 admissions and over 6 million attendances to emergency departments. There are over 17,000 trauma deaths, with nearly 25% of these directly attributable to thoracic injuries. Many of these patients will die at the scene of the injury, with patients reaching hospital already a self-selected group who have a good chance of survival with early appropriate management. Evidence suggests that a significant proportion of in-hospital deaths from thoracic trauma are preventable, with injuries either not being recognised or being inadequately treated.

Only 10–15% of patients with blunt trauma and 15–30% of those with penetrating trauma ultimately require surgery. The remainder can be treated successfully in the emergency department through the application of fundamental principles of initial trauma management as well as through direct interventions within the scope of practice of emergency physicians. These management principles are especially important as thoracic trauma impacts directly on the heart and lungs, the two organs most integral to the provision of oxygenation and perfusion.

Successful management of thoracic trauma depends ultimately on effective prioritisation of resuscitation through the ABC principles with rapid detection and treatment of life-threatening injuries.

Mechanisms and patterns of chest injury

Chest injuries can be broadly classified as penetrating or blunt, the latter encompassing direct blunt trauma as well as crush, acceleration or deceleration injuries and blast injuries. An understanding of the specific mechanisms involved in individual trauma patients is important …

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