Penetrating Thoracic Trauma

About

• Penetration of the partial pleura

Aetiology

• Damage to Heart and Lungs and Major vessels

Clinical

• Hypotension and shock, Chest Pain
• Breathlessness and cyanosis
• Subcutaneous emphysema

Investigations

• 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

Management

• 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