[Management of blunt chest trauma (author's transl)]

The diagnosis of life threatening situations due to blunt chest trauma, the priority of treatment, and therapeutical consequences are discussed. Rib fractures, pulmonary contusions could be treated conservatively. Tension pneumothorax and haemothorax need immediate decompression by intercostal tube drainage. The necessity for prompt exploratory surgery should always be considered in patients with massive haemothorax, tracheobronchial disruption and traumatic rupture of the diaphragm. Rupture or perforation of the oesophagus, traumatic aneurysms of the thoracic aorta, large diaphragmatic herniations, and penetrating thoraco-abdominal wounds demand an early thoracotomy. Indications for late thoracotomy are: clotted haemothorax and diaphragmatic herniations primarily not diagnosed.