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ABC of major trauma. Thoracic trauma--I.

Many patients with catastrophic intrathoracic visceral injury such as laceration of the heart, aorta, or major airways die at the site of incident. Those who reach hospital alive are a self selected group who should survive with early skilled intervention. Yet evidence suggests that most patients who die in hospital of thoracic trauma do so unnecessarily through lack of appropriate treatment. In practice, less than 15 per cent of patients with chest injuries require surgical intervention, pathology in the remainder being confined to the thoracic cage and underlying lung parenchyma. Multiple rib fractures with pulmonary contusion, haemothorax, or pneumothorax can be dealt with simply and effectively by insertion of a chest drain, pain relief, fluid restriction, and physiotherapy. When ignored, underestimated, or inadequately treated, however, such injuries may cause death during surgery for seemingly more important intracranial or abdominal haemorrhage. The basis for successful management of thoracic trauma is effective cardiopulmonary resuscitation followed by early detection and correction of life threatening injuries.