II. Precautions

  1. Trauma in the Elderly
    1. Seemingly mild Chest Trauma may result in serious respiratory compromise and acute distress
  2. Trauma in Children
    1. Intrathoracic injury is common without signs of external thoracic Trauma

III. Exam: Red Flags

  1. Asymmetric breath sounds
  2. Hypertympanic or chest dull to percussion
  3. Parodoxical chest wall movement (Flail Chest)
  4. Palpate thorax for Fractures (Clavicle Fracture, Scapula Fracture, Rib Fracture, Fractured Sternum)

IV. Diagnostics

  1. Portable Chest XRay
    1. Preferred first-line study
  2. Chest CT
    1. See Nexus Chest CT Decision Rule in Blunt Trauma
    2. Indicated for suspected Great Vessel injury (e.g. high velocity accident)
  3. Bedside Ultrasound
    1. See FAST Exam

VI. Management

  1. See specific conditions
  2. Exercise a low threshold for observation or admission (especially in the elderly)
    1. Trauma service as indicated and if available
    2. Observation for 6-8 hours may detect delayed complications (e.g. Pneumothorax, Hemothorax)
  3. Pain management
    1. Critrical, especially in the elderly, to decrease Splinting, Atelectasis and secondary Pneumonia

VII. References

  1. Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-2
  2. (2012) ATLS Manual, 9th ed, American College of Surgeons

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Thoracic Injuries (C0039980)

Definition (MSHCZE) Obecná nebo nespecifikovaná poranění v oblasti hrudníku. R
Definition (MEDLINEPLUS)

The chest is the part of the body between your neck and your abdomen. It includes the ribs and breastbone. Inside your chest are several organs, including the heart, lungs, and esophagus. The pleura, a large thin sheet of tissue, lines the inside of the chest cavity.

Chest injuries and disorders include

Definition (MSH) General or unspecified injuries to the chest area.
Definition (CSP) damage inflicted on the upper part of the trunk as the direct or indirect result of an external force, with or without disruption of structural continuity.
Concepts Injury or Poisoning (T037)
MSH D013898
ICD10 S20-S29.9 , S29.9, S20-S29
SnomedCT 157333008, 213433008, 269341001, 262525000
English Chest Injuries, Injuries, Chest, Injuries, Thoracic, Injury, Chest, Thoracic Injuries, Thoracic Injury, Chest Injury, Injury, Thoracic, Injuries to the thorax, Unspecified injury of thorax, [X]Injuries to the thorax, INJ CHEST, THORACIC INJ, INJ THORACIC, CHEST INJ, Traumatic chest injury NOS, Thoracic Injuries [Disease/Finding], chest traumas, injuries chest, chest injury, thoracic injuries, trauma chest, chest disorders injuries, chest injuries, chest trauma, injuries thorax, thoracic injury, injury thoracic, thorax injuries, Injuries to the thorax (S20-S29), injury of thorax (diagnosis), injury of thorax, injury thorax, Chest Injuries and Disorders, Injury to chest, [X]Injuries to the thorax (disorder), Traumatic injury to chest, Chest injury, Chest injury (disorder), injury; thorax, thorax; injury, thorax; wound, wound; thorax
Italian Traumatismo del torace, Traumatismo del torace NAS, Lesioni toraciche, Lesioni del torace
Dutch traumatisch borstletsel NAO, letsel; thorax, thorax; letsel, thorax; wond, wond; thorax, Niet gespecificeerd letsel van thorax, borstkasletsel, Borstverwonding, borstletsel, Thoraxtrauma, Thoraxtraumata, Trauma, thorax-, Traumata, thorax-
French Lésion traumatique du thorax SAI, Blessures thoraciques, Blessures du thorax, Lésion traumatique du thorax, Traumatismes thoraciques, Traumatismes du thorax, Lésions traumatiques du thorax
German traumatische Brustverletzung NNB, Nicht naeher bezeichnete Verletzung des Thorax, Thoraxverletzung, Brustkorbverletzungen, Thoraxverletzungen
Portuguese Lesão traumática do tórax NE, Lesões do Tórax, Lesões Torácicas, Traumatismos do Tórax, Lesão do tórax, Traumatismos Torácicos
Spanish Lesión traumática del tórax NEOM, [X]lesiones en el tórax (trastorno), [X]lesiones en el tórax, Lesiones Torácicas, Traumatismos del Tórax, injuria torácica (trastorno), injuria torácica, lesión traumática torácica (trastorno), lesión traumática torácica, Herida torácica, Lesiones del Tórax, Traumatismos Torácicos
Japanese 外傷性胸部損傷NOS, ガイショウセイキョウブソンショウNOS, キョウブソンショウ, 胸部外傷, 外傷-胸部, 胸部損傷
Swedish Bröstkorgsskador
Finnish Rintakehävammat
Russian GRUDNAIA KLETKA, TRAVMY, GRUDNOI KLETKI TRAVMY, ГРУДНАЯ КЛЕТКА, ТРАВМЫ, ГРУДНОЙ КЛЕТКИ ТРАВМЫ
Czech Poranění hrudníku, Traumatické poranění hrudníku NOS, hrudník - poranění, poranění hrudníku
Korean 상세불명의 가슴의 손상
Croatian TORAKALNE OZLJEDE
Polish Urazy klatki piersiowej
Hungarian Traumás mellkassérülés k.m.n., Mellkassérülés
Norwegian Skader, brystkasse, Skader, thorax, Toraksskader, Thoraxskader, Brystkasseskader