ABSTRACT
This chapter will describe procedures that are essential to the management of the thoracic trauma patient. Almost all historical accounts of chest trauma are within the context of war and conflict. Distinguishing tension pneumothorax from cardiac tamponade in a trauma patient with hypotension is an essential skill of the trauma surgeon, since most inexperienced evaluators will jump to the conclusion that the hypotension is caused by blood loss. Pneumothorax occurs when air enters the pleural space, usually as a result of parenchymal lung injury in the setting of rib fractures or penetrating trauma. In this setting, simple pneumothorax seen on plain chest X-ray should be treated by tube thoracostomy. Tube thoracostomy is always required following successful needle thoracostomy, which invariably results in a simple pneumothorax regardless of whether one existed prior to its placement. Effective treatment for cardiac tamponade mandates immediate ecompression and repair of the underlying cardiac injury, which requires either a sternotomy or thoracotomy incision.
