Management of chest trauma: a review

The incidence of chest trauma has increased significantly since the turn of the century especially in developed countries where rapid means of transportation has become part of daily life. Although gunshot wounds (GSWs) were the commonest causes of chest trauma in wartime, road traffic accidents (RTAs) have become the scourge of peacetime and modern civilization. Chest trauma is more common in males during the 2nd to the 5th decades of life with an average age of 40 years reducing their life expectancy by another 40 years at the most productive and active period of their lives. Despite improvement in ambulance service and rapid mobilization of victims from the scene of accident, about 10% of chest injured patients will die on the spot and another 5% die within an hour of reaching the hospital. Of the remaining 85%, five percent will require emergency thoracotomy for various reasons while 80% will respond to resuscitative measures and tube thoracostomy drainage alone. The primary aims in the management of chest trauma are prompt restoration of normal cardiorespiratory functions, control of haemorrhage, treatment of associated injuries and prevention of sepsis. Although the overall survival rate of trauma has improved in recent years, deaths are often due to airway obstruction, exsanguinating haemorrhage, flail chest, tension pneumothorax, cardiac tamponade and associated intracranial, intraabdominal and skeletal injuries.