Non-surgical Blunt Chest Trauma

Abstract

Blunt chest injuries are frequent in trauma patients and often tend to pose significant diagnostic and therapeutic challenges to physicians. Chest trauma may not only be lifethreatening because of immediate respiratory and/or hemodynamic failures but also because of delayed worsening of respiratory status within the hours following trauma. In both situations, chest trauma requires appropriate therapeutic intervention to prevent trauma death. For this reason, accurate and complete appraisal of thoracic injuries is crucial. Thoracic ultrasonography and FAST must be conducted in short notice in the trauma setting to evaluate hemodynamically unstable blunt trauma patients since it assesses rapidly vital injuries. After achieving vital signs stabilization, totalbody CT scanning must be performed to detect all thoracic injuries and potential extra-thoracic injuries. Management of patients with blunt chest trauma focuses on interventions such as chest drainage, pulmonary toilet, effective physiotherapy, and early and adequate pain control. Ventilatory support aims at preventing intubation by using high-flow oxygen therapy, continuous positive airway pressure, or non-invasive positive pressure ventilation. When endotracheal intubation and mechanical ventilation are required, the guidelines of protective ventilation must be applied. Hemodynamic resuscitation is guided by multi-modal monitoring to prevent fluid overload in these patients at high risk for developing respiratory failure. In some cases, blunt thoracic trauma requires delayed surgery. Therefore, trained trauma team should be involved in the decision of surgical, endovascular or non-surgical care when pleural active bleeding, flail chest or aortic trauma are identified.