Loss of vital signs due to penetrating chest trauma: Perform resuscitative thoracotomy.

Cardiac tamponade: Perform pericardiocentesisfollowed by pericardial window, or resuscitative thoracotomy.

Traumatic hemothorax: Place chest tube.Open pneumothorax: Place 3-sided occlusive dressing.Tension pneumothorax: Perform emergency chest decompression.Respiratory failure: RSI and mechanical ventilation.Perform the following during the primary survey: Additional testing: bronchoscopy, esophagoscopy, echocardiographyĭo not delay treatment of clinically diagnosed tension pneumothorax to obtain radiologic confirmation.CTA chest if vascular injury is suspected.

See “ Urgent diagnostics for trauma patients” for a comprehensive approach. Penetrating chest wound, e.g., sucking chest woundĬonsider cardiac injury in patients with stab wounds to the cardiac box, i.e., a surface anatomy square bordered superiorly by the sternal notch, inferiorly by the xiphoid process, and laterally by the nipples.Respiratory distress (e.g., tachypnea, hypoxia).Hemorrhagic shock and/or obstructive shock (e.g., hypotension, tachycardia).Assess for indications for urgent thoracotomy.Obtain urgent diagnostics for trauma patients, including CT chest, once stable (see “Diagnostics”).Evaluate for penetrating thoracoabdominal and flank injuries.Examine axillae, back, and flank for wounds that could enter the thoracic cavity.See “ Traumatic circulatory arrest” for the management of cardiac arrest due to trauma.Perform resuscitative thoracotomy if indicated.If at a non- trauma center, initiate transfer to trauma center penetrating injury to the torso is an indication for trauma team activation.Identify and treat respiratory failure and shock, tension pneumothorax, open pneumothorax, massive hemothorax, and cardiac tamponade (see “Treatment” for details).Dense organs (e.g., liver, bone) absorb more kinetic energy than less dense organs, resulting in greater injury.Įnsure the following components are included as part of the standard management of trauma patients using the ATLS algorithm:.The level of injury is related to the kinetic energy of the bullet energy varies based on factors such as bullet weight and velocity.Tissue is displaced forward and radially, resulting in cavitation and pressure injury of nearby structures.Tissue is lacerated and crushed along the path of the bullet.Most deaths are due to firearm-related suicide rather than homicide (2:1).Mortality rate for gunshot injuries in the US is 10.2 per 100,000 adults.Only remove impaled foreign bodies (e.g., knives) in settings where definitive hemostatic control is possible (e.g., operating room) as they might be tamponading injured blood vessels. Tissue is lacerated and torn along the path of the object.The depth of the injury is usually greater than the width.Caused by the thrusting action of a pointed object (e.g., knife, broken bottle).Epidemiology: ∼ 1500 people die from stab wounds annually in the US.Recommendations in this article are consistent with the 2018 ATLS algorithm. Management of penetrating trauma is based on the type and location of the injury.

Hard signs neck trauma