Thoracic Injuries in Combat Casualties in Vietnam

Chest Injuries in Polytrauma

“…It has always been our policy to also drain these occult pneumothoraces in the multitrauma patient who requires longer mechanical ventilation. An emergency thoracotomy is performed, if the initial blood loss after chest tube insertion exceeds 1,500 ml or if there is a continuous blood loss of > 250 ml/h for 3 h. This concept is based on the findings of McNamara et al, who demonstrated during the Vietnam war, that an early thoracotomy in patients with penetrating injuries resulted in a decreased mortality [18]. In our series 6/22 patients could be saved by emergency thoracotomy.…”

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

“…3 During the Second World War, the overall mortality from thoracic trauma had reduced to 9-11% 4 with developments such as endotracheal intubation, mechanical ventilation, the use of antimicrobial agents and improved pulmonary toilet techniques removing retained clots and contamination. 5 In Vietnam, thoracic injury mortality fell further to 2.9%, 6 with the reduction attributable to rapid evacuation rather than advances in surgical technique. 4 Haemorrhage and sepsis have remained the main causes of mortality throughout twentieth century warfare.…”

“…4 Haemorrhage and sepsis have remained the main causes of mortality throughout twentieth century warfare. 1,6 In the recent conflicts in Iraq and Afghanistan, conventional ballistic warfare has given way to counter-insurgency campaigns, characterized by widespread use of Improvised Explosive Devices (IEDs). 7 Casualties maimed by such devices present with multiple injuries, contaminated wounds and significant blood loss.…”

Cardial gunshot injury: treatment in a trauma hospital without a cardiac unit

“…In inner city shootings, the total number of injured with a transmediastinal gunshot wound who reach hospital alive is relatively high compared with war injuries in the field [2][3][4]. With transport time often under 10 min, Patients who arrive in extremis and require emergency room thoracotomy have a small chance of survival.…”