Chest trauma, an overview of the third leading cause of death from physical trauma

By Cristiano Antonino On Apr 21, 2023

Chest trauma is one of the most frequent first aid and ambulance crew medical intervention situations: it must be known accurately, therefore

A person will be diagnosed with chest trauma when they have a serious chest injury, and it must be diagnosed correctly, because it is the third leading cause of death from physical trauma in Western countries

Chest trauma includes gunshot wounds, it can also occur as a result of falls, after being stabbed, hit or beaten.

A diagnosis can be made by a physician, usually with an X-ray.

Chest trauma can be divided into two types:

Penetrating trauma that occurs when the victim suffers an injury that breaks the skin, such as a knife in the chest or a gunshot wound;
Bruising trauma will result in some tearing of the skin, the tear is not the cause of the injury itself and the damage is often less localised. Being kicked by a large animal or being in a car accident can cause blunt trauma.

Blunt trauma accounts for 25% of all deaths due to traumatic medical emergencies.

Chest trauma will present several symptoms, the most common being intense pain and difficulty breathing

Other symptoms will include bleeding, shock, shortness of breath, bleeding, bruising and loss of consciousness, which will occur depending on the cause of the chest trauma.

Fractured bones may also occur due to a thoracic injury.

Chest trauma will be treated depending on the cause; interventions may be required to clear the airway, either in case of lung collapse or to prevent the trauma from causing worse damage and thus resulting in infection.

Trauma to the chest can cause various forms of cardiac injury, such as penetration of a foreign body, rupture, tamponade, laceration and occlusion of coronary arteries, myocardial contusion, pericardial effusion, septal defects, valvular lesions, and rupture of large vessels.

These injuries are often fatal.

Penetrating cardiac injuries are most often caused by blunt weapons or shotguns and result in a mortality rate of between 50% and 85%.

Closed traumas are most frequently associated with a rupture of the heart, with the right ventricle being affected more often than the left, and result in a mortality rate of around 50% in patients who arrive in the emergency room alive.

Following a rupture of a heart chamber or a tear in the coronary arteries or large vessels, blood rapidly fills the pericardial sac and results in cardiac tamponade.

Even as little as 60-100 ml of blood can cause cardiac tamponade and cardiogenic shock, resulting from a reduction in diastolic filling.

Gunshot wounds penetrating the pericardial sac and inside the heart result in rapid haemorrhage, which dominates the clinical picture

Cardiac tamponade following a gunshot wound to the heart is associated with increased survival due to systemic hypotension and increased pressure in the pericardial space, which help to limit haemorrhage.

A cardiac tamponade is often associated with the clinical symptoms of Beck’s triad (jugular venous distension, hypotension and attenuation of cardiac tones).

This triad may not be present in patients who have become hypovolaemic due to haemorrhage.

Radiographic evidence of a widening of the mediastinal shadow may suggest an effusion in the mediastinum and/or tamponade.

Confirmation of a pericardial effusion may be provided by echocardiography.

Emergency exploratory thoracotomy, with cardiopulmonary bypass and surgical correction, and transfusion as required by the clinical condition will be performed.

The anatomopathological changes of the contused heart consist of intramyocardial haemorrhages, myocardial oedema, coronary occlusion, myofibrillar degeneration and necrosis of myocardiocytes.

These lesions lead to arrhythmias and haemodynamic instability similar to those observed after myocardial infarction.

Intubation, ventilation or other methods of oxygenation may also be required; surgery, drug treatment, absolute rest and in some cases physical therapy may also be necessary.

Due to the intensity of the pain, local anaesthetics will be used to alleviate the extent of the pain. Analgesics will be administered by epidural.

Chronic or incurable patients may be provided with a self-controlled infusion to be used on demand to manage pain.

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