Management of chest trauma

Abstract

Trauma is the leading cause of death worldwide. Approximately 2/3 of the patients have a chest trauma with varying severity from a simple rib fracture to penetrating injury of the heart or tracheobronchial disruption. Blunt chest trauma is most common with 90% incidence, of which less than 10% require surgical intervention of any kind. Mortality is second highest after head injury, which underlines the importance of initial management. Many of these deaths can be prevented by prompt diagnosis and treatment. What is the role of the thoracic surgeon in the management of chest trauma in severely injured patients? When should the thoracic surgeon be involved? Is there a place for minimal invasive surgery in the management of severely injured patients? With two case reports we would like to demonstrate how the very specific knowledge of thoracic surgeons could help in the care of trauma patients.

Thoraxchirurgische Aspekte beim Polytrauma

“…Sie ermöglicht dabei minimalinvasiv die Inspektion der Thoraxhöhle zur Detektierung weiterer Verletzungen und deren gleichzeitige Therapie. Außerdem ist die Ausräumung des Hämatothorax möglich, was eine sekundäre Infizierung mit nachfolgendem Pleuraempyem vermeidet [31]. Die Operationszeiten können im Vergleich zur Thorakotomie, in den Händen erfahrener Operateure, deutlich kürzer sein [36].…”

Surgical management of multiple rib fractures/flail chest

“…Blunt trauma accounts for 90% of thoracic trauma and historically less than 10% of all thoracic trauma underwent surgical intervention (9). Chest radiographs are not sensitive enough at picking up the extent of thoracic trauma (58%) (10).…”

Thoraxtrauma: Diagnostik und Therapie

“…Im Rahmen der initialen Untersuchung sollten akut lebensbedrohliche Verletzungen entsprechend den Advanced-Trauma-Life-Support-Prinzipien (ATLS-Prinzipien) nach dem Airway-Breathing-Circulation-Disability-Exposure/Environment-Algorithmus identifiziert und dementsprechend behandelt werden [4,5]. Die Mortalität ist in der 1.…”