Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma. Most haemothoraces are the result of rib fractures, lung parenchymal and minor venous injuries, and as such are self-limiting. Less commonly there is an arterial injury, which is more likely to require surgical repair.
An overview of pneumothoraces - diagnosis & management
Diagnosis & management of simple pneumothorax
Indications and technique of resuscitative thoracotomy
Emergency department thoractomy is performed in the emergency room for patients in traumatic arrest or profoundly shocked. This article discusses the indications for emergency department thoracotomy and describes the operative technique and resuscitative management of these patients.
A primer on the FAST exam
A primer on the FAST ultrasound examination.
The diagnosis and management of tension pneumothorax.
Diagnosis and management of tension pneumothorax.
Intercostal Chest Drains
Intercostal Chest Drains
Drainage of the pleural space by means of a chest tube is the commonest intervention in thoracic trauma, and provides definitive treatment in the majority of cases. While a relatively simple procedure, it carries a significant complication rate, reported as between 2% and 10%. While many of these complications are relatively minor, some require operative intervention and deaths still occur.
Chest Trauma Pneumothorax - Tension
Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect. Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest.
Hypoxia and hypoventilation are the primary killers of acute trauma patients. Assessment of ventilation is therefore given high priority in the primary survey - as the second ‘B’ or Breathing stage. It may be obvious that there is a ventilatory problem during assessment of the airway. Similarly, the identification or actual severity of certain conditions may only be determined subsequently, after assessment of the circulation or the use of monitoring or diagnostic adjuncts.
Chest wall injury is a extremely common following blunt trauma. It varies in severity from minor bruising or an isolated rib fracture to servere crush injuries of both hemithoraces leading to respiratory compromise.
Pulmonary contusion is an injury to lung parenchyma, leading to oedema and blood collecting in alveolar spaces and loss of normal lung structure & function. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance.