Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury

Thoracic trauma is common and causes a variety of injuries, ranging from simple abrasions and contusions to life-threatening insults to the thoracic viscera. Thoracic trauma also is associated with a high morbidity. Twenty percent of all trauma deaths involve chest injury, making it second only to head and spinal cord injuries [1]. Fortunately, most thoracic injuries do not require major surgical intervention. Most chest wall and intrathoracic injuries can be managed with simple tube thoracostomy, mechanical ventilation, aggressive pain control, and other supportive care. The elderly and other patients with diminished pulmonary reserve are the most vulnerable for pulmonary deterioration and will require critical care observation at the least. Because critical care physicians will encounter patients with pulmonary and chest wall injuries frequently, an in-depth knowledge of the pathophysiology and treatment of thoracic trauma is necessary.