Unstable Penetrating Chest Trauma

Annotation for Point L

If penetrating injury involves the lower third of the thorax and there is evidence of abdominal injury, laparotomy may be the appropriate initial maneuver. The decision to perform thoracotomy or laparotomy first is determined by clinical findings, chest tube output, chest radiograph, and/or Focused Assessment with Sonography in Trauma (FAST). As a practical manner, it does not really matter which is performed first, as long as the goal is rapid exposure and damage control. In essence, exploration should start where the majority of the hemorrhage is originating.³³