Thoracic trauma is common and causes a variety of injuries, ranging from simple abrasions
and contusions to life-threatening insults to the thoracic viscera. Thoracic trauma
also is associated with a high morbidity. Twenty percent of all trauma deaths involve
chest injury, making it second only to head and spinal cord injuries [
[1]
]. Fortunately, most thoracic injuries do not require major surgical intervention.
Most chest wall and intrathoracic injuries can be managed with simple tube thoracostomy,
mechanical ventilation, aggressive pain control, and other supportive care. The elderly
and other patients with diminished pulmonary reserve are the most vulnerable for pulmonary
deterioration and will require critical care observation at the least. Because critical
care physicians will encounter patients with pulmonary and chest wall injuries frequently,
an in-depth knowledge of the pathophysiology and treatment of thoracic trauma is necessary.To read this article in full you will need to make a payment
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References
- Epidemiology of chest trauma.Surg Clin North Am. 1989; 69: 15-19
- Injury facts. 2002 edition. National Safety Council, Itasca (IL)2002
- A prospective study of 413 consecutive car occupants with chest injuries.J Trauma. 1984; 24: 129-135
- Blunt thoracic trauma. Analysis of 515 patients.Ann Surg. 1987; 206: 200-205
- Biomechanics of the human chest, abdomen and pelvis in lateral impact.Accid Anal Prev. 1989; 21: 553-574
- Mechanical factors associated with posterior rib fractures: laboratory and case studies.Pediatr Radiol. 1997; 27: 87-91
- Experimental study of blast injuries to the lungs.Lancet. 1940; 2: 219-224
- Physiological effects of air concussion.Am J Physiol. 1924; 67: 219-274
- Explosions and blast injuries.Ann Emerg Med. 2001; 37: 664-678
- The morbidity and mortality of rib fractures.J Trauma. 1994; 37: 975-979
- Three or more rib fractures as an indicator for transfer to a level I trauma center: a population study.J Trauma. 1990; 30: 689-694
- Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion.J Trauma. 1988; 28: 298-304
- Rib fractures in the elderly.J Trauma. 2000; 48: 1040-1047
- Chest injuries in children: an analysis of 100 cases of blunt chest trauma from motor vehicle accidents.J Pediatr Surg. 1992; 27: 551-555
- A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma.Ann Emerg Med. 2002; 39: 492-499
- Health care cost and use project's nationwide inpatient sample.(Accessed July 17, 2002)
- Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients.J Trauma. 2001; 50: 684-688
- Noncorrelation between thoracic skeletal injuries and acute traumatic aortic tear.J Trauma. 1997; 43: 400-404
- Fracture of the upper ribs and injury to the great vessels.Surg Gynecol Obstet. 1989; 169: 275-282
- Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.J Trauma. 1997; 43: 405-412
- Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients.Arch Surg. 1998; 133: 1084-1088
- Pediatric and adult thoracic trauma: age related impact on presentation and outcome.Ann Thorac Surg. 1994; 58: 14-18
- Rib fractures in children: a marker of severe trauma.J Trauma. 1990; 30: 695-700
- Epidemiology of minimal trauma rib fractures in the elderly.Calcif Tissue Int. 1998; 62: 274-277
- Symptomatic fracture incidence in elderly men and women: the Dubbo osteoporosis epidemiology study (DOES).Osteoporos Int. 1994; 4: 277-282
- Acute pain management of patients with multiple fractured ribs.J Trauma. 2003; 54: 615-625
- Continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with multiple fractured ribs.Chest. 2003; 123: 424-431
- A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia.J Trauma. 1990; 30: 799-805
- Age-adjusted outcomes in traumatic flail chest injuries in the elderly.Am Surg. 2000; 66: 978-981
- Factors affecting prognosis in patients with flail chest.J Thorac Cardiovasc Surg. 1970; 60: 402-410
- Selective management of flail chest and pulmonary contusion.Ann Surg. 1982; 196: 481-487
- Chest wall distortion in patients with flail chest.Am Rev Respir Dis. 1989; 140: 31-37
- Operative chest wall stabilization in flail chest—outcomes of patients with or without pulmonary contusion.J Am Coll Surg. 1998; 187: 130-148
- Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation.J Thorac Cardiovasc Surg. 1995; 110: 1676-1680
- Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.J Trauma. 2002; 52: 727-732
Mayberry J.C., Terhes J.M., Ellis T.J., Wanek S.M., Mullins R.J. Absorbable plates for rib fracture repair: preliminary experience. J Trauma, in press
- Thoracoscopic resection of painful multiple rib fractures: case report.J Trauma. 2002; 52: 391-392
- Outcome of isolated pulmonary contusion in blunt trauma patients.Am Surg. 1994; 60: 138-142
- Pulmonary contusion: quantifying the lesions on chest x-ray films and the factors affecting prognosis.J Trauma. 1999; 46: 833-838
- ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high risk patients.J Trauma. 2001; 51: 223-230
- Pulmonary contusion: CT vs. plain radiograms.J Comput Assist Tomogr. 1989; 13: 417-420
- Quantitation and pattern of parenchymal lung injury in blunt chest trauma: Diagnostic and therapeutic implications.J Comput Tomogr. 1988; 12: 270-281
- Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma.Crit Care Med. 2000; 28: 1370-1375
- Computed tomography of the chest in blunt thoracic trauma: results of a prospective study.J Trauma. 1997; 43: 13-18
- Pulmonary contusion: review of the clinical entity.J Trauma. 1997; 42: 973-979
- Crystalloid resuscitation of patients with pulmonary contusion.Am J Surg. 1984; 148: 145-151
- Determinants of outcome after pulmonary contusion.J Trauma. 1986; 26: 695-697
- Lung bacterial clearance following pulmonary contusion.Surgery. 1979; 86: 730-735
- Long-term disability after flail chest injury.J Trauma. 1984; 24: 410-414
- Long-term disability associated with flail chest injury.Am J Surg. 1985; 150: 324-326
- Pulmonary disability after severe blunt chest trauma.J Trauma. 1990; 30: 562-567
- Pulmonary Contusion causes long-term respiratory dysfunction with decreased functional residual capacity.J Trauma. 1991; 31: 1203-1210
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© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
