Blunt Chest Wall Trauma
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.
KeywordsAdvanced trauma life support (ATLS) Advanced cardiac life support (ACLS) Blunt aortic injury Blunt trauma Echocardiogram Focused assessment with sonography for trauma (FAST) Hemothorax Incentive spirometry Mechanical ventilation Pneumothorax Pulmonary toilet Rib fractures Rib plating thoracic trauma
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