Most patients with chest injuries arriving at the casualty department of the district general hospital do not require intensive care; the same applies to head injuries. Commonly the patient can be admitted to the accident ward or even despatched home. A minority are quickly transported from the casualty to the ICU and a further group, admitted initially to the accident ward, requires intensive care because a relatively minor injury develops into a serious one. Of the patients admitted 1o the ICU a few percent require thoracic surgery and this often necessitates transfer to the regional thoracic centre. These varied migrations are shown in Figure 15.1. A chest injury, especially when of the crushed chest variety or when associated with injuries to the head or abdomen, requires repeated assessments by a doctor who has the appropriate skills and knowledge. This doctor may be consultant to the accident and emergency department or physician to the ICU. A clear policy is drawn up so that the experienced doctor is promptly summoned to casualty or the accident ward to help in the assessment. Parallel arrangements are made with the medical and first-aid personnel in industry and the ambulance teams responsible for road traffic accidents. In this case the object is to bring the experienced doctor to the site of the accident so that the initial assessment and resuscitation are made before transporting the patient.
KeywordsChest Wall Pulmonary Oedema Adult Respiratory Distress Syndrome Pleural Space Thoracic Surgeon
Unable to display preview. Download preview PDF.
References and Bibliography
- Avery, E. E., Mörch, E. T., Head, J. R. and Benson, D. W. (1959). Severe crushing injuries of the chest; a new method of treatment with continuous mechanical hyperventilation by means of intermittent positive endotracheal insufflation. Q. Bull. Northwestern Univ. Med. School, 39, 301Google Scholar
- Keen, G. (1975). Chest Injuries. (Bristol: John Wright & Sons Ltd)Google Scholar
- Moore, F. D., Lyons, J. H., Pierce, E. C., Morgan, A. P., Drinker, P. A., MacArthur, J. D. and Dammin, G. J. (1969). Post-Traumatic Pulmonary Insufficiency. (Philadelphia: W. B. Saunders Co.)Google Scholar