78 - Thoracic Trauma

The most common mechanism of blunt thoracic trauma is an MVC, followed by falls, assaults, and crush injuries. Compressive forces directly injure the thoracic cage and underlying viscera and result in rib fractures and pulmonary contusion. Deceleration produces traction on fixed structures such as the isthmus of the aorta and the carina and results in traumatic aortic and tracheobronchial injuries. Blunt thoracic trauma causes penetrating thoracic trauma when rib or clavicle fractures impale thoracic or abdominal viscera. Gunshot wounds and stab wounds are the most common mechanisms of penetrating thoracic trauma. Low-velocity stab wounds disrupt only the structures penetrated. Mediumvelocity handguns and high-velocity military assault rifles produce temporary and permanent cavities of tissue damage. Missile injuries to the thorax often involve multiple anatomic regions, including the neck, diaphragm, abdomen, and retroperitoneum.