Introduction

Chest trauma is estimated to be the primary cause of death in 25% of traumatic mortalities and a contributing factor in another 25% of deaths. Good understanding of the pathophysiology of chest trauma and timely selection of the appropriate investigations and treatment are all critical components for optimal outcome.

Clinical Examination

Advanced trauma life support (ATLS) principles are particularly important in the initial evaluation and management of the chest trauma patient.

During the primary survey, there are six lifethreatening conditions that need to be identified and treated:

1. Airway obstruction

2. Tension pneumothorax

3. Open pneumothorax with a “sucking wound”

4. Flail chest

5. Massive hemothorax

6. Cardiac tamponade

During the secondary survey, there are another six potentially lethal chest injuries that should be identified and treated. The diagnosis of these conditions may need more complex and time-consuming investigations.

1. Lung contusion

2. Myocardial contusion

3. Aortic rupture

4. Diaphragmatic rupture

5. Tracheobronchial rupture

6. Esophageal injury

Investigations

History and clinical examination will determine the type and timing of investigations necessary for the safe and efficient evaluation of the chest trauma patient. Very often, in unstable patients, therapeutic interventions such as thoracostomy tube insertion or thoracotomy may be initiated without any investigations.