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Thoracic Trauma


  • Tension pneumothorax/simple pneumothorax
  • Hemothorax
  • Flail chest
  • Sucking chest wound
  • Pericardial tamponade
  • Vascular injury
  • Rib fractures


  • More common in penetrating injury
  • May be the cause of hypovolemic shock
  • Urgently place large chest drain Less than 1500-2000 ml bleed that stops after drain placement - drainage alone often suffices If greater bleed or bleeding continues at more than 200-300ml/hour, thoracotomy may be needed

Rib fractures

  • May contuse or puncture underlying lung causing pneumothorax
  • May occur with minimal injury in elderly
  • May require block for pain management

Flail chest

  • Unstable segment of chest—emergency
  • Needs to be treated with positive pressure ventilation, analgesia

Pulmonary contusion

  • Common after blunt chest injury
  • Onset of symptoms may be slow, progressive over 24h
  • Signs and symptoms:
    • Dyspnoea
    • Hypoxemia
    • Tachycardia
    • Rare or absent breath sounds
    • Rib fractures


  • Rib fractures
      - Since ribcage in children is much more pliable, they may have extensive chest injury without rib fractures
  • Pulmonary contusions
  • Pneumothorax
  • Hemothorax
  • All need urgent review by a surgeon experienced in paediatric surgery or referral
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