Thoracic Surgery for the Acute Care Surgeon by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030484934
Publisher: Springer International Publishing

Chest Wall Injury

Associated Injuries

Up to 25% of patients with chest wall injuries have one or more associated injuries. Fractures of the first and second ribs, scapula, and sternum have long been associated with significant intrathoracic injury. This association is less prominent than previously thought, but fractures of these robust boney structures indicate that a great deal of kinetic energy has been transmitted to the thorax. Underlying pulmonary contusion is frequently associated with blunt chest wall trauma, and sternal fractures may be associated with cardiac contusion. Pneumothorax and hemothorax are frequently associated injuries.

The geriatric patient tolerates chest wall injury, pneumothorax, and hemothorax poorly. Concomitant cardiorespiratory comorbidities such as COPD and reduced physiologic reserves make this population ill-equipped to handle the stress of thoracic injury. Elderly patients with relatively minor chest wall injury may develop respiratory compromise soon after injury, but very frequently develop progressive respiratory insufficiency over the initial 48–72 hour after injury. Such patients should be closely observed in a monitored area for respiratory deterioration. In the pediatric population, the rib cage is extremely pliable. Therefore, pediatric patients may have significant intrathoracic injury in the absence of rib or sternal fractures, and the severity of their intrathoracic injuries may be missed.

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