Stable Penetrating Chest Trauma

Annotation for Point A

Patients who are hemodynamically stable, maintaining a patent airway, or have a secure airway with evidence of good oxygenation, without obvious ongoing air leak or bleeding are initially assessed according to Figure 2 with adherence to Advanced Trauma Life Support guidelines. Clinical examination can be incorrect in up to one third of cases when assessing for hemothorax and/or pneumothorax, although it is still the criterion standard for initial assessment.34  In stable patients, it is reasonable to obtain a CXR before performing tube drainage. Marking entrance and exit sites can be helpful, and in gunshot wounds, abdominal films may be required to define the trajectory of missiles. Centers with expertise in ultrasonography may choose to use this technique as a screening tool to detect pneumothorax and/or hemothorax.21