THORACIC TRAUMA PENETRATING

See Truncal penetration

See Abdominal penetration

RESUSCITATION

Breathing

• Needle thoracocentesis if tension pneumothorax
• UWSD if haemothorax (avoid site of penetration)

Circulation

• If arrested (thorocotomy/cross clamp aorta) 
• Establish IV access contra-lateral to thoracic injury
• Insert CVC (if required) to side of thoracic injury [avoids two pneumothoraces]
• Blood grouping
• If unstable consider limited resuscitation and immediate OT

ONGOING MANAGEMENT

Definite indications for thoracotomy		OT
If unstable
If FAST/echo shows pericardial fluid
If UWSD 1500ml initial or 300ml/hr continuous
Possible need for thoracotomy		CT chest or aortography or VAT
CXR - haemopneumothorax or wide mediastinum

OTHER INVESTIGATIONS

OTHER MANAGEMENT

• IV antibiotic prophylaxis if oesophageal injury suspected

DISPOSITION

Operating theatre 

All unstable or definite injuries

Investigate and surgical opinion

All possible injuries

Observe (at least 24 hrs in HDU/ICU) for developing signs of injury

All patients (symptomatic or not)