Penetrating Chest Trauma


This is a recommended algorithm of the Western Trauma Association for the acute management of penetrating chest injury. Because of the paucity of recent prospective randomized trials on the evaluation and management of penetrating chest injury, the current algorithms and recommendations are based on available published cohort, observational and retrospective studies, and the expert opinion of the Western Trauma Association members. The two algorithms should be reviewed in the following sequence: Figure 1 for the management and damagecontrol strategies in the unstable patient and Figure 2 for the management and definitive repair strategies in the stable patient. Figure 1 will discuss damage-control techniques; Figure 2 will focus on more definitive repairs. Because of the variety of possible mechanisms, presentation, injury sites, and operative approaches,we recognize that therewill be variability in decision making, local resources, institutional consensus, and patientspecific factors that may require deviation from the algorithms presented. The algorithms and accompanying text represent our consensus for a safe and reasonable approach in these complex cases and attempts to incorporate historically validated approaches with the advent of newer imaging, interventional, resuscitative, operative, and selective/expectant management approaches.