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ABC Medical

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Penetrating Thoracic Trauma

  • Penetration of the partial pleura
  • Damage to Heart and Lungs and Major vessels
  • Hypotension and shock, Chest Pain
  • Breathlessness and cyanosis
  • Subcutaneous emphysema
  • FBC, Clotting, Amylase, U&E
  • Group and cross match
  • CXR - Air in pleural space, Blood in pleural space, air or blood in the mediastinum
  • Toxicology screen
  • Cardiac echo for blood in pericardial sac and heart trauma
  • CT scan may be useful
  • Ensure Airway, breathing, circulation
  • Disability , Exposure. High FiO2
  • Full survey to assess other injuries
  • If conscious sit up with chest to knees
  • Keep bleeding lung downside
  • If tension pneumothorax suspected then insert a cannula in 2nd space anteriorly and do not wait for CXR.
  • Place chest drain in 5th space midaxillary line as expected for any trauma associated PTX/haemothorax
  • Analgesia to prevent splinting
  • Two large bore IV lines give crystalloid/colloid
  • Group and cross match for blood
  • Immediate Surgical assessment for thoracotomy
  • Leave foreign bodies until experts arrive and bleeding can be controlled
  • Flail chest needs intermittent positive pressure ventilation
  • Cardiac tamponade needs pericardiocentesis or thoracotomy
Life threatening Complications
  • Hypovolaemic shock
  • Cardiac tamponade/contusion
  • Tension Pneumothorax
  • Mediastinal injury, Mediastinitis
  • Oesophageal damage
  • Diaphraghamatic rupture
  • Aortic disruption, Lung abscess, Pneumonia

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