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. 1989 Jun;6(2):97–106. doi: 10.1136/emj.6.2.97

An audit of the management of 250 patients with chest trauma in a regional thoracic surgical centre.

N S Jones 1
PMCID: PMC1285577  PMID: 2742679

Abstract

Two hundred and fifty patients with chest trauma admitted consecutively over a 6-year period to the Royal Surrey County Hospital were reviewed. This is a large series by British standards. The cause and nature of their chest and associated injuries were studied, together with the management, complications and outcome. The aim of this study was to find areas where diagnosis and treatment could be improved. It was found that where there was no lung contusion, flail chest injuries could be managed without ventilation. The review suggests that even small traumatically induced pneumothoraces should be drained. It illustrates the need for an awareness of the wide range of concurrent problems in patients with chest injuries and the variety of possible complications.

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Selected References

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  1. Dougall A. M., Paul M. E., Finely R. J., Holliday R. L., Coles J. C., Duff J. H. Chest trauma--current morbidity and mortality. J Trauma. 1977 Jul;17(7):547–553. [PubMed] [Google Scholar]
  2. Fleming W. H., Bowen J. C. Early complications of long-term respiratory support. J Thorac Cardiovasc Surg. 1972 Nov;64(5):729–738. [PubMed] [Google Scholar]
  3. Hamilton J. R., Dearden C., Rutherford W. H. Myocardial contusion associated with fracture of the sternum: important features of the seat belt syndrome. Injury. 1984 Nov;16(3):155–156. doi: 10.1016/0020-1383(84)90151-7. [DOI] [PubMed] [Google Scholar]
  4. James O. F., Moore P. G. Causes of death after blunt chest injury. Aust N Z J Surg. 1983 Feb;53(1):37–42. doi: 10.1111/j.1445-2197.1983.tb02392.x. [DOI] [PubMed] [Google Scholar]
  5. Newman R. J. Chest wall injuries and the seat belt syndrome. Injury. 1984 Sep;16(2):110–113. doi: 10.1016/s0020-1383(84)80010-8. [DOI] [PubMed] [Google Scholar]
  6. Phillips E. H., Rogers W. F., Gaspar M. R. First rib fractures: incidence of vascular injury and indications for angiography. Surgery. 1981 Jan;89(1):42–47. [PubMed] [Google Scholar]
  7. Richardson J. D., Adams L., Flint L. M. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982 Oct;196(4):481–487. doi: 10.1097/00000658-198210000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Richardson J. D., McElvein R. B., Trinkle J. K. First rib fracture: a hallmark of severe trauma. Ann Surg. 1975 Mar;181(3):251–254. doi: 10.1097/00000658-197503000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Shackford S. R., Smith D. E., Zarins C. K., Rice C. L., Virgilio R. W. The management of flail chest. A comparison of ventilatory and nonventilatory treatment. Am J Surg. 1976 Dec;132(6):759–762. doi: 10.1016/0002-9610(76)90453-0. [DOI] [PubMed] [Google Scholar]
  10. Shackford S. R., Virgilio R. W., Peters R. M. Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg. 1981 Feb;81(2):194–201. [PubMed] [Google Scholar]
  11. Shin B., McAslan T. C., Hankins J. R., Ayella R. J., Cowley R. A. Management of lung contusion. Am Surg. 1979 Mar;45(3):168–175. [PubMed] [Google Scholar]
  12. Thompson G. A., Wilson T., Collins R. E., Broadley J. A. Chest injuries in a district general hospital. Ann R Coll Surg Engl. 1982 Mar;64(2):117–120. [PMC free article] [PubMed] [Google Scholar]
  13. Trinkle J. K., Furman R. W., Hinshaw M. A., Bryant L. R., Griffen W. O. Pulmonary contusion. Pathogenesis and effect of various resuscitative measures. Ann Thorac Surg. 1973 Dec;16(6):568–573. doi: 10.1016/s0003-4975(10)65037-0. [DOI] [PubMed] [Google Scholar]
  14. Trinkle J. K., Richardson J. D., Franz J. L., Grover F. L., Arom K. V., Holmstrom F. M. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975 Apr;19(4):355–363. doi: 10.1016/s0003-4975(10)64034-9. [DOI] [PubMed] [Google Scholar]
  15. Worthley L. I. Thoracic epidural in the management of chest trauma. A study of 161 cases. Intensive Care Med. 1985;11(6):312–315. doi: 10.1007/BF00273543. [DOI] [PubMed] [Google Scholar]

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