[Practical aspects of thoracic injuries]

While mortality is about one per hundred in patients with injuries to the chest wall it is one in five in patients with internal thoracic injuries. The mortality is dependent on the total severity of injuries, and upon age. Closed, blunt thoracic trauma may initially present few signs and symptoms. Internal injuries, such as pneumothorax and haemothorax may be present. Decompression by thoracic drainage improves oxygenation. This may be crucial for the prognosis in multitrauma, particularly in cases of concomitant head injury. Treatment and diagnosis of thoracic injuries have first priority in the multitraumatized patient. A chest X-ray should be obtained early, and should be repeated, possibly supplemented by a CT-scan. When pneumothorax or haemothorax is suspected, and in cases of penetrating injury, chest drainage is widely used. In cases of chest injury and unexplained shock, cardiac tamponade must be excluded by subxiphoidal incision.