Thoracic Trauma

THORACIC TRAUMA

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

Hemothorax

• 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

THORACIC TRAUMA IN CHILDREN

• 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