Diagnostic Dilemmas and Current Controversies in Blunt Chest Trauma
Section snippets
Blunt aortic injury
Blunt aortic injury is the second most common cause of death in blunt trauma patients [1]. Common mechanisms that induce blunt aortic injury are rapid deceleration injuries from motor vehicle or motorcycle crashes, falls, and crush injuries [2]. Blunt aortic injuries result in nearly 8000 deaths a year in the United States [3]. Classically, over 80% of patients who suffer blunt aortic injuries die on scene, whereas 13% to 15% of patients who survive the initial injury make it to the hospital
Blunt cardiac injury
Blunt cardiac injury is usually sustained in rapid deceleration injuries with direct blows to the chest. There is no standard definition of blunt cardiac injury and no straightforward or accurate way to establish the diagnosis. The exact incidence of blunt cardiac injury is unknown but is estimated to range from 8% to 71% of all blunt chest injured patients. This large variation in incidence and the lack of agreement between researchers as to the definition of blunt cardiac injury make
Blunt diaphragmatic rupture
Blunt diaphragmatic rupture most often occurs as a result of severe blunt chest and abdominal trauma resulting from motor vehicle crashes or vehicles striking pedestrians, as well as falls from a height of 10 ft or more. The reported incidence of blunt diaphragmatic rupture ranges from 0.5% to 8% of patients admitted to the emergency department as a result of automobile crashes or undergoing exploratory laparotomy for trauma [37], [38], [39]. Fifty percent to 80% of blunt diaphragmatic ruptures
The role of antibiotics in chest tube thoracostomy
Chest tube placement in blunt chest trauma is a common procedure. More than 100,000 chest tubes are placed annually in trauma patients [48]. Large-bore chest tubes (36-F or higher) are often placed to drain traumatic hemothorax, traumatic pneumothorax, or in traumatic arrest. Complications with chest tube insertion are well known, and they include intra-abdominal tube placement, intrathoracic misplacement, lung parenchyma injury, intercostal artery or nerve injury, or post-procedural infectious
Summary
The management and evaluation of blunt chest trauma is an ever changing field. The use of helical CT scans has allowed for rapid diagnosis and exclusion of blunt aortic injury. The evaluation of blunt myocardial injury is difficult; however, a normal EKG in a patient with blunt chest trauma essentially rules out a significant risk of blunt myocardial injury. Blunt diaphragmatic injury is a relativity rare occurrence but carries a high morbidity and mortality if diagnosis is significantly
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2020, InjuryCitation Excerpt :Furthermore, the model does not account for societal costs such as lost wages and workplace productivity. Regardless, based on our results, with over 100,000 TTs placed annually in the United States for traumatic injury [30], adoption of a clinical observation strategy could yield over $82,000,000 in cost savings each year. Importantly, our analysis takes into account health effectiveness, QALYs, which has not been evaluated previously.
Chest Tube Management Practices by Trauma Surgeons
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