Abstract
All patients presenting to the emergency department with blunt chest wall trauma should be initially evaluated following advanced trauma life support protocols, including the primary survey. Screening imaging should be performed (focused assessment with sonography for trauma [FAST] exam or portable chest x-ray), and any life-threatening injuries, including pneumothorax, hemothorax, and pericardial effusion, should be immediately addressed. If the patient is stable, then computed tomography (CT) chest angiography should be performed to assess for any possible injuries and appropriate management based on specific etiology. If the patient is unstable, continue resuscitation, and if the patient responds and stabilizes, CT chest angiography should be performed to assess injury to the heart, lungs, great vessels, and bony thorax. If the patient remains unstable despite further resuscitation, re-evaluate for life-threatening injuries, consider blunt cardiac injury, and follow ACLS protocols for any arrhythmias. The management of many blunt chest wall injuries is conservative, including respiratory support with mechanical ventilation, appropriate pain management, and aggressive pulmonary toilet and chest physiotherapy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
American College of Surgeons. Advanced trauma life support. 9th ed. Chicago: American College of Surgeons; 2012. 336 p.
American Heart Association. Advanced cardiac life support. Dallas: American Heart Association; 2015. 183 p.
Galvagno SM, Smith CE, Varon AJ, Hasonboehler EA, Sultan S, Shaefer G, et al. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81(5):936–51.
Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618–26.
Legome E, Hammel JM. Initial evaluation and management of chest wall trauma in adults. Up to Date [Internet]. 2016 Sep [cited 2017 Aug 14]. Available from: https://www.uptodate.com/contents/initial-evaluation-and-management-of-chest-wall-trauma-in-adults.
Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T, et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351–61.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Manley, N.R., Maish, G.O. (2019). Blunt Chest Wall Trauma. In: Docimo Jr., S., Pauli, E. (eds) Clinical Algorithms in General Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-98497-1_155
Download citation
DOI: https://doi.org/10.1007/978-3-319-98497-1_155
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98496-4
Online ISBN: 978-3-319-98497-1
eBook Packages: MedicineMedicine (R0)