Chapter 52 Blunt Chest Trauma (Case 35)
Case: A 67-year-old male appeared to sustain blunt trauma to the chest in a head-on collision.
Differential Diagnosis
Editor’s note: The previous chapter reviews penetrating chest trauma. Four clinical entities that comprise the differential dx for penetrating chest trauma are again considered in the differential dx for blunt trauma. Review the following clinical entities in the previous chapter:
The most common injuries to the chest wall—fractures of the ribs, sternum, and clavicle—are rarely life threatening, but they may portend more significant underlying visceral or neurovascular injury. I focus on six entities that are immediately life threatening:
The primary survey (ABCs) of the ATLS algorithm will direct me to evaluate for these six conditions first; only after assessment of hemodynamic stability and stabilization of airway, breathing, and circulation do I proceed to the secondary survey (complete head-to-toe physical examination), which includes a neurological examination to rule out spinal injury.
Chest radiography assists in the dx of pneumothorax, hemothorax, chest wall injuries, or pulmonary contusions. Focused assessment sonography in trauma (FAST) examination will rule out cardiac tamponade and will assist in the dx of associated abdominal injury.
Once primary and secondary surveys are completed, I usually obtain chest, abdominal, and pelvic CT scans in stable patients. Unstable patients may need urgent operative intervention, but ED thoracotomy in blunt trauma is virtually never successful.
