BLUNT THORACIC INJURIES
Written by Rhiana Devadasan
Blunt chest trauma = injury that affects any one or all components of the chest wall and thoracic cavity. Includes the bony skeleton (ribs, clavicles, scapulae, and sternum); lungs and pleurae; the tracheobronchial tree; the oesophagus; the heart; the great vessels of the chest; and the diaphragm.
Signs & Symptoms:
- Bruising
- Hypoxia, ventilation-perfusion mismatch, hypovolemia, ↓cardiac output
Effects of Blunt Thoracic Trauma:
= highly dependent on the intensity of the trauma (can vary from harmless contusions to life-threatening injuries of the heart/aorta).
- Chest wall injuries normally lead to difficulty in breathing due to severe pain associated w/ them.
- Direct lung injuries, such as pulmonary contusions, are associated with major chest trauma and impair ventilation by a similar mechanism.
- Shunting and dead-space ventilation produced by these injuries can also impair oxygenation.
- Blunt trauma that causes significant cardiac injuries or severe great-vessel injuries frequently results in death before adequate treatment can be provided.
- This is due to immediate loss of cardiac pump function, which causes hypovolemic or cardiogenic shock and then death.
- The most immediate life-threatening injuries that may occur include tension pneumothorax, open pneumothorax, hemothorax, flail chest, cardiac tamponade, airway obstruction/rupture.
Treatment & Prognosis:
- CT scans to identify injuries (as they are not always outwardly visible).
- Majority of patients with blunt chest trauma (~80%) require no invasive therapy and have a great prognosis.
- Cardiac injuries however normally have a worse prognosis and are associated with high morbidity and mortality rate.
- Normally only a tube thoracostomy is required (e.g. for intercostal drainage for pneumothorax).
- A less common procedure that may be employed is a pericardiocentesis which by removing blood surrounding the heart, permits the heart to regain some ability to appropriately pump blood.
- Under certain circumstances, an emergent thoracotomy is done.