Priorities in diagnosis and treatment of blunt chest injuries

The evaluation of thoracic injuries is only one aspect of the total assessment of a severely injured patient. In a series of 675 hospitalized patients, blunt chest injury was associated with craniocerebral injury in 55 per cent, with abdominal injuries in 20 per cent and with fractures of the extremities in 38 per cent. Both diagnostic and therapeutic procedures go hand in hand. Immediately life-threatening situations (hypovolaemia, respiratory insufficiency, tension pneumothorax and cardiac tamponade) should be diagnosed by clinical signs and treated before radiographs are taken. The chest radiograph is the basic tool for diagnosis of thoracic injuries, although it will not reveal a possible impairment of lung function. Special attention should be paid, and further evaluation is necessary, in suspected rupture of the diaphragm (present in 4 per cent), rupture of the aorta (2 per cent), bronchial rupture (0.5 per cent) and cardiac contusion (16 per cent). Most blunt thoracic injuries can be treated adequately by intercostal tube drainage. Operative intervention has been found necessary in 8 per cent of cases. Indications for thoracotomy are clearly defined.