Chest trauma accounts for 10 percent of patient’s admissions in health care centers. It is associated to violence that injures the mediastinal great vessels resulting to lethal complications and eventual death. An injury in the thoracic areas extends to the great vessels causing high fatality rates. Decision making process in cases involving chest trauma differs, the main reason careful scrutiny is important on the risk versus benefit ratio in each case. The fatal outcomes can be thwarted by careful resuscitative plans, dearly recognition and careful- thought- of interventions. Respiratory therapists have an important role in managing patients with chest trauma.
All patients with chest wounds and upper abdomen injuries faces danger of intrathoracic and mediastinal injuries. In Nigeria, chest trauma is the secondary infections inflicted by stabs with the most victims being males.
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If a patient is hemodynamically unstable due to the injury, cardiac injury should be suspected especially if it is on the left chest wall. Research has shown that only 17 percent of victims survive from chest trauma involving stabs. The risk index for small prognosis are thoracotomy on the left and cardiac injury (Alexis et al. 2017).
Ultrasonogram and echocardiogram are the suitable recommendation for screening cardiac tamponade and hemopneumothorax in patients since they have a high predictability of up to 77 percent. Intervenous fluids for resuscitation in patients with hypotension are frowned upon as it has detrimental outcomes. There exists very little evidence for administration of small aliquots to clinical response.
It is universally agreed that non mediastinal peripheral injuries be managed using test tube thoracostomy. For cardiac temponade, urgent periocardiocentesis is advisable as the condition is life threatening. Echo-guided procedures have proved a high success as they pose minor complications and provide the best anatomical approach among apical, subcostal and parasternal approaches.
In a nut-shell, patients with injuries on the anterior chest wall are likely to have them on the mediastinal great vessels as well as on the heart. A large extent suspicion for major vascular injury e-FAST and echocardiogram may assist in making reliable decisions. Early thoracotomy in the operation room is deemed the best option in cases with major vascular and cardiac injuries.
References
Alexis, J., Pandit, V. R., Maroju, N. K., & Antony, J. (2017). Penetrating chest injury involving pulmonary artery: Challenges at emergency department. Nigerian Journal of Cardiovascular & Thoracic Surgery , 2 (2), 41.
http://www.nigjourcvtsurg.org/text.asp?2017/2/2/41/231277
