The management of thoracic injuries.

WITH THE roads daily becoming choked with fast cars, Casualty Departments throughout the country are increasingly familiar with major chest injuries. The crushing forces applied to the chest as the driver is thrown against the steering column, and the stresses imposed upon mediastinal structures by rapid deceleration in head-on collision often produce injuries so severe that death is instantaneous. In those fortunate enough to reach hospital, resuscitative measures must be applied immediately and often by doctors untrained in thoracic surgery. London (1963) found ninetythree chest injuries in a series of 551 casualties admitted to the Birmingham Accident Hospital, and of these, sixty-eight had other important lesions. The principles underlying the management of thoracic trauma are straightforward and their application involves only a few easily acquired techniques. Abrams (1961a) succinctly defined the causes of death from chest injury as 'the lethal triad, bleeding, drowning and suffocation', and it is under these headings that the treatment of thoracic injuries will be considered.