Thoracic injuries in the Yom Kippur war. Experience in a base hospital

Forty-two patients were treated for combat injuries of the chest, caused by shrapnel fragments, bullet wounds, blunt trauma and blast injury. Twenty-three required only intercostal tube drainage, while 19 underwent thoracotomy. There were two deaths, both unrelated to the thoracic injury. Our indications for emergency thoracotomy were hemorrhage of 1,000 ml with the initial insertion of the chest tube or 500 ml of fresh bleeding during the first 2 hr after insertion of the chest tube, massive air leak, extensive chest wall injury, the location of metal fragments in the mediastinum, evidence of cardiac tamponade or significant mediastinal shift. The positive results obtained in this series of cases were due to the effective first aid treatment on the battlefield and in field hospitals, and to an aggressive policy of operative intervention where indicated, together with intensive postoperative care.