Unstable Penetrating Chest Trauma
Annotation for Point M
Delayed closure is appropriate in patients who manifest thoracic compartment syndrome and/or who have diffuse bleeding and are persistently unstable. It will be readily apparent when attempting to close the chest and manifests as a drop in blood pressure and/or sudden rise in airway pressure. Retractors can be left in place, or the skin can be loosely closed. Persistent cardiac dysfunction can be managed with an intra-aortic balloon pump.