Introduction

Approximately 25 percent of nonmilitary trauma-related deaths are due to thoracic trauma. A majority of the deaths occur after the patient reaches the hospital. Mortality is relatively low (5 percent) for isolated chest injuries. With two or more organ systems involved, death will occur in about one-third. It is felt that as many as 10 percent of such deaths could have been prevented in the ED.1

Penetrating injuries have a different mechanism than blunt trauma. Nearly all penetrating injuries result in a pneumothorax, with hemothorax occurring in more than 75 percent. Blunt trauma causes injury by one or more of several mechanisms: compression (organ rupture), direct trauma (e.g., fracture), and acceleration/deceleration forces (vessel shear and tear). Penetrating trauma has the further distinction of being associated with abdominal injuries in about one-third of cases. Only 5 to 15 percent of patients with chest trauma will require a thoracotomy.

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