Abstract
The guiding principles behind acute management of patients suffering thoracic trauma have changed little in the past three decades. All patients should be evaluated and triaged according to the guidelines presented in Advanced Trauma Life Support (ATLS). The majority of patients will be managed without requiring operative intervention. Stable patients with periclavicular and transmediastinal gunshot wounds should have a CT angiogram as part of their evaluation. Unstable patients with penetrating chest wounds have a high likelihood of requiring massive transfusion (>10 U PRBC in 24 h), and such a situation should be anticipated. Although the indications for performing a resuscitative thoracotomy have evolved since its inception, this procedure should be reserved for victims of penetrating trauma with witnessed physiologic parameters arriving to the trauma center within 15 min of EMS arrival. The incision of choice for patients requiring an urgent exploration will be determined by mechanism, trajectory, and anticipated injuries. Following completion of their operation, patients should be managed in the ICU, warmed, and have their coagulopathy corrected to prevent further blood loss and deterioration.
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Milia, D.J., Paul, J.S. (2014). Overview of Chest Trauma. In: Dua, A., Desai, S., Holcomb, J., Burgess, A., Freischlag, J. (eds) Clinical Review of Vascular Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39100-2_11
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DOI: https://doi.org/10.1007/978-3-642-39100-2_11
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