Class

Presentation
on
Chest Injury Presented by,
Tabasum Hasan
M.Sc. Nursing 2nd Year
W.B.G.C.O.N
IPGME&R and SSKM Hospital
Introduction
 Approximately 60% of all multisystem trauma
victims have some type of chest or thoracic
trauma.
 Thoracic injuries are the cause of death in 20% to
25% of all trauma victims
 Injury to the chest wall is found in 45% of these
thoracic trauma victims.
DEFINITION
 Chest injury is the damage to the structure in the
chest cavity (lungs or heart) caused by an
accidental deliberate penetration of foreign object
into the chest or a blunt trauma leading to rib
fracture, bruises, lung and chest contusion.
INCIDENCE
 A trauma-related death is reported every 1.9
minutes in India.
 Nearly 20 million are hospitalized every year due
to injuries out which 1 million die due to trauma-
related injuries.
 Chest trauma accounts for about 10% of all
trauma admissions and 25–50% of trauma deaths
globally.
RELATED ANATOMY AND
PHYSIOLOGY
 CAUSES
Blunt injury Penetrating injury
 Motor vehicle accident  Knife stabbing
 Fall  Gunshot
 Assault with blunt object  Stick Arrow
 Crush injury
 Explosion
 Sports injury
 TYPES
 Traumatic injuries fall into two major categories:
(1) Blunt trauma (3) Countercoup trauma

(4) Compression
(2) Penetrating trauma
 Blunt trauma
 Blunt trauma occurs when the body is struck by a blunt
object, such as a steering wheel.
 The types of forces involved in blunt Chest trauma
injuries include deceleration, acceleration, shearing, and
compression. The external injury may appear minor, but
the impact may cause severe,
 Life-threatening internal injuries, such as a ruptured
spleen.
 Penetrating trauma
 It occurs when a
foreign body
impales or passes
through the body
tissues (e.g.,
gunshot wounds,
stabbings).
Countercoup trauma
 A type of blunt trauma, is caused by the impact of parts of the
body against other objects. This type of injury differs from blunt
trauma primarily in the velocity of the impact. Internal organs
are rapidly forced back and forth (acceleration-deceleration
injury) within the bony structures that surround them so that
internal injury is sustained not only on the side of the body
impacted but also on the opposite side, where the organ or
organs hit bony structures.
 If the velocity of impact is great enough, organs and blood
vessels can literally be torn from their points of origin. This is
the shearing injury that can cause transection of the aorta,
haemothorax, and diaphragmatic rupture injuries.
Compression
 Injury occurs when the body cannot handle the
degree of external pressure during blunt trauma,
resulting in contusions, crush injuries, and organ
rupture.
Pathophysiology
 Assessment and Diagnostic
Findings
History regarding-
 Time of injury
 Mechanism of injury
 Level of responsiveness
 Specific injuries
 Estimated blood loss
 Recent drug or alcohol use
 Prehospital treatment
 The initial assessment of thoracic injuries includes
 Assessment of the patient for airway obstruction, tension
pneumothorax, open pneumothorax, massive haemothorax, flail
chest, and cardiac tamponade.
 These injuries are life-threatening and need immediate treatment.
 Secondary assessment would includes
 Simple pneumothorax, haemothorax, pulmonary contusion,
traumatic aortic rupture, tracheobronchial disruption, oesophageal
perforation, traumatic diaphragmatic injury, and penetrating
wounds to the mediastinum.
 Although listed as secondary, these injuries may be life-
threatening as well depending upon the circumstances.
 The physical examination
 Many patients with injuries involving the chest have associated head and
abdominal injuries that require attention.
 Inspection of the airway, thorax, neck veins, and breathing difficulty.
 Assessing the rate and depth of breathing for abnormalities, such as stridor,
cyanosis, nasal flaring, use of accessory muscles, drooling, and overt trauma
to the face, mouth, or neck.
 The chest should be assessed for symmetric movement, symmetry of breath
sounds, open chest wounds, entrance or exit wounds, impaled objects,
tracheal shift, distended neck veins, subcutaneous emphysema, and
paradoxical chest wall motion.
 In addition, the chest wall should be assessed for bruising, petechiae,
lacerations, and burns.
 The vital signs and skin colour are assessed for signs of shock.
 The thorax is palpated for tenderness and crepitus; the position of the trachea
is also assessed.
Diagnostic evaluation
 Chest x-ray
 CT scan
 Complete blood count
 Clotting studies
 Type and cross match, electrolytes, arterial blood gas
analysis, and ECG
Medical Management
 Airway establishment, intubation and ventilator support if
needed.
 Re-establishing fluid volume and negative intrapleural
pressure and draining intrapleural fluid and blood.
 Stabilizing and re-establishing chest wall integrity,
occluding any opening into the chest (open pneumothorax),
and draining or removing any air or fluid from the thorax to
relieve pneumothorax, haemothorax, or cardiac tamponade.
 Hypovolemia and low cardiac output must be corrected
along with the control of haemorrhage, are usually carried
out simultaneously at the scene of the injury or in the
emergency department.
Sternal and rib fractures
 Sternal fractures are most common
in motor vehicle crashes with a
direct blow to the sternum via the
steering wheel and are most
common in women, patients over
age 50, and those using shoulder
restraints.
 Rib fractures are the most common
type of chest trauma, occurring in
more than 60% of patients admitted
with blunt chest injury.
 Most rib fractures are benign and
are treated conservatively.
Sternal and rib fractures
 Fractures of the first three ribs are
rare but can result in a high
mortality rate because they are
associated with laceration of the
subclavian artery or vein.
 The fifth through ninth ribs are the
most common sites of fractures.
 Fractures of the lower ribs are
associated with injury to the spleen
and liver, which may be lacerated
by fragmented sections of the rib.
 Clinical manifestations
The patient with sternal fractures has
 Anterior chest pain
 Overlying tenderness
 Ecchymosis
 Crepitus
 Swelling
Clinical manifestations
The patient with rib fractures has-
 Severe pain

 Point tenderness
 Muscle spasm over the area of the fracture, which
is aggravated by coughing, deep breathing, and
movement.
 The area around the fracture may be bruised.
 Assessment and diagnostic findings
 The patient with a sternal fracture must be closely
evaluated for underlying cardiac injuries.
 A crackling, grating sound in the thorax (subcutaneous
crepitus) may be detected with auscultation.
 Continuous pulse oximetry, and arterial blood gas
analysis
 The diagnostic study includes a chest x-ray, rib films of
a specific area, ECG
 Medical management
Sternal fracture Rib fracture
 controllingpain  control pain
 Avoiding excessive  Detect and treat the
activity injury
 Treating any associated
injuries
Flail chest
 Flail chest is frequently a
complication of blunt chest trauma
from a steering wheel injury.
 It usually occurs when three or more
adjacent ribs (multiple contiguous
ribs) are fractured at two or more
sites, resulting in free-floating rib
segments. It may also result as a
combination fracture of ribs and
costal cartilages or sternum.
 As a result, the chest wall loses
stability and there is subsequent
respiratory impairment and usually
severe respiratory distress
Pathophysiology
Medical management
 The specific management depends on the degree of respiratory
dysfunction.
 If only a small segment of the chest is involved, the objectives are
to clear the airway through positioning, coughing, deep breathing,
and suctioning to aid in the expansion of the lung, and to relieve
pain by intercostal nerve blocks, high thoracic epidural blocks, or
cautious use of intravenous opioids
 For mild to moderate flail chest injuries, the underlying pulmonary
contusion is treated by monitoring fluid intake and appropriate
fluid replacement, while at the same time relieving chest pain.
Pulmonary physiotherapy focusing on lung volume expansion and
secretion management techniques are performed. The patient is
closely monitored for further respiratory compromise.
Continue…

 When a severe flail chest injury is encountered,

endotracheal intubation and mechanical ventilation are
required to provide internal pneumatic stabilization of the
flail chest and to correct abnormalities in gas exchange.
This helps to treat the underlying pulmonary contusion,
serves to stabilize the thoracic cage to allow the fractures to
heal, and improves alveolar ventilation and intrathoracic
volume by decreasing the work of breathing. This treatment
modality requires endotracheal intubation and ventilator
support. Differing modes of ventilation are used depending
on the patient’s underlying disease and specific needs.
 In rare circumstances, surgery may be required to more quickly
stabilize the flail segment. This may be used in the patient who is
difficult to ventilate or the high-risk patient with underlying lung
disease who may be difficult to wean from mechanical ventilation.
 Regardless of the type of treatment, the patient is carefully
monitored by serial chest x-rays, arterial blood gas analysis, pulse
oximetry, and bedside pulmonary function monitoring. Pain
management is key to successful treatment. Patient-controlled
analgesia, intercostal nerve blocks, epidural analgesia, and
intrapleural administration of opioids may be used to control
thoracic pain
Pulmonary Contusion
Pulmonary Contusion
Pulmonary contusion is observed in about 20% of
adult patients with multiple traumatic injuries and in a
higher percentage of children due to increased compliance
of the chest wall.
 It is defined as damage to the lung tissues resulting in
haemorrhage and localized edema.
 It is associated with chest trauma when there is rapid
compression and decompression to the chest wall (i.e.,
blunt trauma). It may not be evident initially on
examination but will develop in the post traumatic period
Pathophysiology
 Clinical manifestations
 Pulmonary contusion may be mild, moderate, or severe.
 The clinical manifestations vary from tachypnea, tachycardia, pleuritic
chest pain, hypoxemia, and blood-tinged secretions to more severe
tachypnea, tachycardia, crackles, frank bleeding, severe hypoxemia,
and respiratory acidosis. Changes in sensorium, including increased
agitation or combative irrational behaviour, may be signs of
hypoxemia.
 In addition, the patient with moderate pulmonary contusion has a large
amount of mucus, serum, and frank blood in the tracheobronchial tree;
the patient often has a constant cough but cannot clear the secretions.
 A patient with severe pulmonary contusion has the signs and symptoms
of ARDS; these may include central cyanosis, agitation, combativeness,
and productive cough with frothy, bloody secretions.
 Assessment and diagnostic findings
1. The efficiency of gas exchange is determined by pulse
oximetry and arterial blood gas measurements.
2. Pulse oximetry is also used to measure oxygen saturation
continuously.
3. The chest x-ray may show pulmonary infiltration. The
initial chest x-ray may show no changes; in fact, changes
may not appear for 1 or 2 days after the injury.
 Medical management
 Treatment priorities include maintaining the airway, providing adequate
oxygenation, and controlling pain.
 In mild pulmonary contusion, adequate hydration via intravenous fluids and
oral intake is important to mobilize secretions. However, fluid intake must be
closely monitored to avoid hypervolemia.
 Volume expansion techniques, postural drainage, physiotherapy including
coughing, and endotracheal suctioning are used to remove the secretions.
 Pain is managed by intercostal nerve blocks or by opioids via patient-
controlled analgesia or other methods.
 Usually, antimicrobial therapy is administered because the damaged lung is
susceptible to infection.
 Diuretics may be given to reduce edema.
 Supplemental oxygen is usually given by mask or cannula for 24 to 36 hours.
 A nasogastric tube is inserted to relieve gastrointestinal distention.
 Continue..

 The patient with moderate pulmonary contusion may require

bronchoscopy to remove secretions; intubation and mechanical
ventilation with PEEP may also be necessary to maintain the
pressure and keep the lungs inflated.
 The patient with severe contusion may develop respiratory
failure and may require aggressive treatment with endotracheal
intubation and ventilatory support, diuretics, and fluid
restriction. Colloids and crystalloid solutions may be used to
treat hypovolemia.
 Antimicrobial medications may be prescribed for the treatment
of pulmonary infection. This is a common complication of
pulmonary contusion (especially pneumonia in the contused
segment), because the fluid and blood that extravasates into the
alveolar and interstitial spaces serve as an excellent culture
medium.
Continue….

 The patient with moderate pulmonary contusion may require

bronchoscopy to remove secretions; intubation and mechanical
ventilation with PEEP may also be necessary to maintain the
pressure and keep the lungs inflated.
 The patient with severe contusion may develop respiratory failure
and may require aggressive treatment with endotracheal intubation
and ventilatory support, diuretics, and fluid restriction. Colloids
and crystalloid solutions may be used to treat hypovolemia.
 Antimicrobial medications may be prescribed for the treatment of
pulmonary infection. This is a common complication of
pulmonary contusion (especially pneumonia in the contused
segment), because the fluid and blood that extravasates into the
alveolar and interstitial spaces serve as an excellent culture
medium.
PENETRATING TRAUMA
 PENETRATING TRAUMA
Gunshot wound Stab wounds
 Stab wounds are generally  Gunshot wounds to the chest
considered of low velocity may be classified as of low,
because the weapon destroys a
small area around the wound. medium, or high velocity. A
Knives and switchblades cause bullet can cause damage at
most stab wounds. The the site of penetration and
appearance of the external along its pathway. It also may
wound may be very deceptive,
ricochet off bony structures
because pneumothorax,
haemothorax, lung contusion, and damage the chest organs
and cardiac tamponade, along and great vessels.
with severe and continuing
hemorrhage, can occur from
any small wound
Medical Management
 The objective of immediate management is to restore and maintain
cardiopulmonary function.
 After an adequate airway is ensured and ventilation is established, the patient is
examined for shock and intrathoracic and intra-abdominal injuries.
 The patient is undressed completely so that additional injuries will not be
missed. There is a high risk for associated intra-abdominal injuries with stab
wounds below the level of the fifth anterior intercostal space. Death can result
from exsanguinating hemorrhage or intraabdominal sepsis.
 After the status of the peripheral pulses is assessed, a large-bore intravenous line
is inserted.
 The diagnostic workup includes a chest x-ray, chemistry profile, arterial blood
gas analysis, pulse oximetry, and ECG. Blood typing and cross-matching are
done in case blood transfusion is required. An indwelling catheter is inserted to
monitor urinary output.
 A nasogastric tube is inserted to prevent aspiration, minimize leakage of
abdominal contents, and decompress the gastrointestinal tract.
 Continue..
 Shock is treated simultaneously with colloid solutions, crystalloids, or
blood, as indicated by the patient’s condition. Chest x-rays are obtained,
and other diagnostic procedures are carried out as dictated by the needs
of the patient (e.g., CT scans of chest or abdomen, flat plate x-ray of the
abdomen, abdominal tap to check for bleeding).
 A chest tube is inserted into the pleural space in most patients with
penetrating wounds of the chest to achieve rapid and continuing re-
expansion of the lungs.
 The insertion of the chest tube frequently results in a complete
evacuation of the blood and air.
 The chest tube also allows early recognition of continuing intrathoracic
bleeding, which would make surgical exploration necessary.
 If the patient has a penetrating wound of the heart and great vessels, the
esophagus, or the tracheobronchial tree, surgical intervention is required.
 Pneumothorax
 Pneumothorax occurs when the
parietal or visceral pleura is
breachedand the pleural space is
exposed to positive atmospheric
pressure.
 Normally the pressure in the pleural
space is negative or sub atmospheric
compared to atmospheric pressure;
this negative pressure is required to
maintain lung inflation.
 When either pleura is breached, air
enters the pleural space, and the lung
or a portion of it collapses.
TYPES
pneumothorax

Traumatic Simple
Pneumothorax Pneumothorax

Open Closed Tension

Simple pneumothorax
 A simple, or spontaneous, pneumothorax occurs when air
enters the pleural space through a breach of either the
parietal or visceral pleura.
 Most commonly this occurs as air enters the pleural space
through the rupture of a bleb or a bronchopleural fistula.
 A spontaneous pneumothorax may occur in an apparently
healthy person in the absence of trauma due to rupture of an
air-filled bleb, or blister, on the surface of the lung,
allowing air from the airways to enter the pleural cavity.
 It may be associated with diffuse interstitial lung
disease and severe emphysema
 Traumatic Pneumothorax
 Traumatic pneumothorax occurs when air
escapes from a laceration in the lung itself
and enters the pleural space or enters the
pleural space through a wound in the chest
wall.
 It can occur with blunt trauma (e.g., rib
fractures) or penetrating chest trauma.
 Traumatic pneumothorax resulting from
major injury to the chest is often
accompanied by haemothorax (collection
of blood in the pleural space resulting
from torn intercostal vessels, lacerations of
the great vessels, and lacerations of the
lungs).
Case scenario
 A 17-year-old male presented to our clinic with his mother
complaining of chest pain for the prior two days. The patient
reported the chest pain started the day prior to the
presentation after falling on his back while he was playing
football for his high school. He was attempting to catch a
football when he fell directly on his back after being tackled,
and he stated, "the wind was knocked out of me." He was
able to get back into the game after he caught his breath, but
reported that he continued to feel as though there was
"something inside of my chest." The patient took 400 mg
ibuprofen tablets twice daily with no improvement in his
pain. He denied hitting his head or neck and having no loss
of consciousness. No fever, visual disturbances, dizziness,
headache, neck pain, shortness of breath, abdominal pain,
nausea/vomiting/diarrhea, or any other symptoms were
reported.
 X-ray demonstrates
pneumomediastinum
(yellow arrows), with
an apical
pneumothorax (blue
arrow), and free air in
the supraclavicular
soft tissue (red arrow)

Chest X-ray of traumatic chest

injury
Lateral chest X-ray Yellow arrows: pneumomediastinum
Clinical Manifestations
 Pain is usually sudden and may be pleuritic.
 The patient may have only minimal respiratory distress with
slight chest discomfort and tachypnea with a small simple or
uncomplicated pneumothorax.
 If the pneumothorax is large and the lung collapses totally, acute
respiratory distress occurs. The patient is anxious, has dyspnea
and air hunger, has increased use of the accessory muscles, and
may develop central cyanosis from severe hypoxemia.
 Severe chest pain may occur, accompanied by tachypnea,
decreased movement of the affected side of the thorax, a
tympanic sound on percussion of the chest wall, and decreased
or absent breath sounds and tactile fremitus on the affected side.
Medical Management
 The goal of treatment is to evacuate the air or blood from the pleural
space.
 A small chest tube (28 French) is inserted near the second intercostal
space
 If the patient also has a haemothorax, a large-diameter chest tube (32
French or greater) is inserted, usually in the fourth or fifth intercostal
space at the mid axillary line. The tube is directed posteriorly to drain the
fluid and air.
 Once the chest tube or tubes are inserted and suction is applied (usually to
20 mm Hg suction), effective decompression of the pleural cavity
(drainage of blood or air) occurs. If an excessive amount of blood enters
the chest tube in a relatively short period, an auto transfusion may be
needed. This technique involves taking the patient’s own blood that has
been drained from the chest, filtering it, and then transfusing it back into
the patient’s vascular system.
 Traumatic open pneumothorax calls for emergency interventions. Stopping the
flow of air through the opening in the chest wall is a life-saving measure.In
such an emergency, anything may be used that is large enough to fill the chest
wound - a towel, a handkerchief, or the heel of the hand. If conscious, the
patient is instructed to inhale and strain against a closed glottis. This action
assists in re expanding the lung and ejecting the air from the thorax.
 In the hospital, the opening is plugged by sealing it with gauze impregnated
with petrolatum. A pressure dressing is applied.
 Usually, a chest tube connected to water-seal drainage is inserted to permit air
and fluid to drain.
 Antibiotics usually are prescribed to combat infection from contamination.
 The severity of open pneumothorax depends on the amount and rate of thoracic
bleeding and the amount of air in the pleural space.
Continue…
 The pleural cavity can be decompressed by needle aspiration
(thoracentesis) or chest tube drainage of the blood or air. The
lung is then able to re-expand and resume the function of gas
exchange.
 As a rule of thumb, the chest wall is opened surgically
(thoracotomy) when more than 1,500 mL of blood is aspirated
initially by thoracentesis (or is the initial chest tube output) or
when chest tube output continues at greater than 200 mL/hour.
 The urgency with which the blood must be removed is
determined by the respiratory compromise.
 An emergency thoracotomy may also be performed in the
emergency department if there is suggested cardiovascular injury
secondary to chest or penetrating trauma.
Tension Pneumothorax
 A tension pneumothorax occurs when air is drawn into the pleural
space from a lacerated lung or through a small hole in the chest wall.
 It may be a complication of other types of pneumothoraxes.
 In contrast to open pneumothorax, the air that enters the chest cavity
with each inspiration is trapped; it cannot be expelled during
expiration through the air passages or the hole in the chest wall.
 In effect, a one-way valve or ball valve mechanism occurs where air
enters the pleural space but cannot escape. With each breath, tension
(positive pressure) is increased within the affected pleural space.
 This causes the lung to collapse and the heart, the great vessels, and
the trachea to shift toward the unaffected side of the chest
(mediastinal shift).
Clinical manifestations
 Air hunger
 Agitation
 Increasing hypoxemia
 Central cyanosis
 Hypotension
 Tachycardia
 Profuse diaphoresis
 Radiographic features
A tension pneumothorax will have the same features
as a simple pneumothorax with a number of
additional features, helpful in identifying tension.
These additional signs indicate hyper expansion of
the hemi thorax
 Ipsilateral increased intercostal spaces
 contralateral shift of the mediastinum
 Depression of the hemi diaphragm
Hemithorax hyper expansion
Mediastinal shift
Hemidiaphragm depression
Medical management
 If a tension pneumothorax is suspected, the patient should
immediately be given a high concentration of supplemental
oxygen to treat the hypoxemia, and pulse oximetry should be
used to monitor oxygen saturation.
 In an emergency, a tension pneumothorax can be decompressed
or quickly converted to a simple pneumothorax by inserting a
large-bore needle (14-gauge) at the second intercostal space,
midclavicular line on the affected side. This relieves the pressure
and vents the positive pressure to the external environment.
 A chest tube is then inserted and connected to suction to remove
the remaining air and fluid, re-establish the negative pressure,
and re-expand the lung.
Continue…
 Ifthe lung re-expands and air leakage from the lung
parenchyma stops, further drainage may be unnecessary.
 If a prolonged air leak continues despite chest tube drainage
to underwater seal, surgery may be necessary to close the
leak.
CARDIAC TAMPONADE

 Cardiac tamponade is the compression of the

heart as a result of fluid within the
pericardial sac.
 It usually is caused by blunt or penetrating
trauma to the chest.
 A penetrating wound of the heart is
associated with a high mortality rate.
 Cardiac tamponade also may follow
diagnostic cardiac catheterization,
angiographic procedures, and pacemaker
insertion, which can produce perforations of
the heart and great vessels Relief of tension
pneumothorax, is considered an emergency
measure.
SUBCUTANEOUS
EMPHYSEMA
 No matter what kind of chest trauma the patient has,
when the lung or the air passages are injured, air
may enter the tissue planes and pass for some
distance under the skin (e.g, neck, chest).
 The tissues give a crackling sensation when
palpated, and the subcutaneous air produces an
alarming appearance as the face, neck, body, and
scrotum become misshapen by subcutaneous air.
 Fortunately, subcutaneous emphysema is of itself
usually not a serious complication. The
subcutaneous air is spontaneously absorbed if the
underlying air leak is treated or stops spontaneously.
 In severe cases in which there is widespread
subcutaneous emphysema, a tracheostomy is
indicated if airway patency is threatened.
Nursing Diagnosis
1. Ineffective breathing pattern related to secondary to
trauma resulting in musculoskeletal impairment and
pain.
2. Increased risk of secondary complications such as
hypoxia, pneumonia, respiratory failure and cardiac
dysrhythmias related to the thoracic injury.
3. Increased potential complications of hypovolemia
related to bleeding
4. Acute pain related to the chest injury
5. Ineffective airway clearance related to the lung
parenchymal injury secondary to thoracic injury
6. Anxiety related to weightlessness and fear.
NURSING MANAGEMENT
 Ensure the patency of airway.
 Check SPO2 by pulse oximeter.
 Administer high flow oxygen with non-rebreather mask. If needed
mechanical ventilation support should be given to patient.
 Establish IV access with large bore catheter. Start fluid resuscitation as
needed.
 Remove the clothing to assess injury.
 Cover sucking chest wound with nonporous dressing taped on three sides.
 Assess for other significant injury.
 Stabilize fail rib segment with hand followed by application of tape
horizontal across the flail segment.
 In case of haemothorax or pneumothorax chest tube insertion with chest
drainage system is done.
Chest Drainage
Related research
1. A retrospective study was carried out by W.S Bhupindar, Dugg
Pankaj et al.(November,2021) named Clinical Features, Management, and
Outcomes of Chest Trauma at a Tertiary-Care Centre in India: A Retrospective
Observational Study for chest trauma patients including poly-
trauma(n=184) from hospital records for five years(2016-2020) in
tertiary care centre .Various parameter including demographic profile,
mode of injury, management and out-comes were studied.
The result showed that Mean age of patients was 37 ± 16 years with a
male to female ratio of 2.4 : 1. Road traffic injuries remained the most
common cause of trauma followed by assaults.Among the type of
injuries, abrasions were most common (n = 76) followed by bruises,
hemothorax, and fracture ribs . However, there were multiple findings
in some cases. Exclusive chest injuries were seen in less number of
patients (n = 57).Most of the patients were managed conservatively
(55.43%). Mortality was seen in only 1.63% patients.
continue……
2. Eshetu Yimam Abubeker , Mustofa Salh Yalew et.al.
(December,2021) conducted a study named Mortality rate and factors
associated with death in traumatic chest injury patients: A retrospective
study. The study was done from June 2016 to June 30, 2020. Data was
collected from patients’ chart.
The study result revealed that The majority of patients (55.8%) sustained
blunt chest injuries and violence (52.5%) was the leading cause of
injuries. Hemopneumothorax (27.7.0%), hemothorax (22.9%) and rib
fracture (17.2%% were the most common type of injuries. Associated
extra-thoracic injuries were noted in 70.4% of patients, from those,
extremity injury (22.2%), head/neck injuries (21.7%) and abdominal
injuries (18.1%) were the commonest. Most patients (64.7%) were treated
successfully with chest tube. Nearly, one third (35.3%) had complications
including pneumonia (13.8%) and Atelectasis (12.6%). The mean length
of hospital stay was 9.40 days. The overall traumatic chest injury mortality
rate was 26%. Mortality was significantly associated with age >50 year.
Prognosis
 The prognosis for a patient who has sustained
thoracic trauma can be very different. It is
determined by degree of injury, as well as the
patient’s underlined co-morbidities.
 CONCLUSION
 Thoracic injury is common in both high-energy and low-energy
trauma and is associated with significant morbidity and mortality.
As with the management of all traumas, thoracic trauma
evaluation requires a systematic approach, first prioritizing
airway, respiration, and circulation, followed by a focused
secondary survey. Unlike other forms of trauma, chest injuries
have the potential to progress rapidly and require prompt
procedural intervention in the emergency room. Because of this
urgency, physicians must have a high level of situational
awareness and pay close attention to physical examination
findings. Once the primary survey is complete and stable, the
secondary survey is crucial in uncovering most thoracic injuries
and guiding effective care.