BLUNT CHEST TRAUMA

Blunt chest trauma is the leading cause of thoracic injuries in German y, penetrating chest injuries are rare. Hereby, single or multiple rib fractures, hemato-pneumothorax and pulmonary contusion represent the most common injuries. The early management of thoracic injuries consis ts of detection and sufficient therapy of acute life threatening situa tions like tension pneumothorax, acute respiratory insufficiency or se vere intrathoracic bleeding. Most of the isolated thoracic injuries a re adequately treated by conservative means, sufficient analgesia, dra inage of intrapleural air or blood, physiotherapy and clearance of bro nchial secretions provided; operative intervention is rarely indicated . In multiple injured patients however, severe blunt chest trauma and especially pulmonary contusion negatively affects outcome with a signi ficant increase of morbidity and mortality. Hence, patients with this combination of pulmonary injuries, such as lung contusion and associat ed severe injuries, carry a particular high risk of respiratory failur e, ARDS and MOF with a considerable mortality. Therefore, early exact diagnosis of all thoracic injuries is essential and can be achieved by thoracic computed tomography, which becomes more and more popular in this setting. Early intubation and PEEP-ventilation, alternate prone a nd supine positioning of multiple injured patients with lung contusion and differentiated concepts of volume-and catecholamine therapy repre sent the basic therapeutic principles. Additionally, the entire early trauma management of multiple injured patients must focus on the prese nce of pulmonary contusion. Every additional burden on their pulmonary microvascular system like microembolization during femoral nailing, t he trauma burden of extended surgery or mediator release in septic sta les may cause rapid decompensation and organ failure and therefore, ha s to be avoided.