Complications
Pneumonia can occur in patients with impaired ventilation and has a high mortality in thoracic trauma.[63]
Often occurs with rib fractures. Presents mainly as a sudden shortness of breath, dry cough, cyanosis, and pain felt in the chest, back, and/or arms. Subcutaneous emphysema can occur.
In penetrating chest wounds, the sound of air flowing through the puncture hole may indicate pneumothorax, hence the term 'sucking' chest wound. The flopping sound of a punctured lung is also occasionally heard. If untreated, hypoxia and impaired systemic venous return (tension pneumothorax) may lead to loss of consciousness and coma.
Treatment involves draining the pneumothorax with percutaneous needle aspiration, chest drain, or surgical intervention.
Often occurs with rib fractures. Tachypnoea, cyanosis, decreased or absent breath sounds on affected side, tracheal deviation to unaffected side, dull resonance on percussion, unequal chest rise, tachycardia, hypotension, and pale, cool, clammy skin are typical examination findings.
Results from high-impact blunt chest trauma, leading to oedema, blood collecting in alveolar spaces, and loss of normal lung structure and function. It develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance, and decreased lung compliance. Pulmonary contusion is associated with an increased risk of pneumonia, acute respiratory distress syndrome, and hypoxaemia necessitating ventilatory support.[66] Chest x-ray or a computed tomography scan is used to determine the complication.
Often occurs as a result of significant blunt thoracic trauma. Management of haemodynamically unstable patients with potential aortic injury is to rapidly identify and control ongoing haemorrhage from other sites, and to minimise blood pressure lability and large shear stresses on the aortic wall. Clinical signs of traumatic aortic injury are rarely present, and diagnosis is based on mechanism of injury and the results of imaging studies. Chest x-ray, computed tomography (CT) scan, CT angiography, and angiogram are used.
Chest x-ray can show mediastinal widening, blunting of the aortic knob, depression of the left mainstem bronchus, and rightward tracheal/oesophageal deviation.[67]
In patients with isolated rib fractures, pain is present but gradually declines over 4 months. The average time off work is about 70 days following chest trauma with or without concomitant injuries.[64]
Retrospective data suggest that approximately 30% of patients who were working prior to major trauma with rib fractures will not return to work within the 24 month post-injury period.[65]
Thrombus formation in the venous system can occur following trauma leading to pulmonary embolism; right heart failure and cardiac arrest may ensue if not aggressively treated.
Non-union of a rib fracture is rare but can occur. These may be treated with plate fixation.[68]
Severe trauma can cause ARDS. There is a significant increase in pneumothorax, pneumonia, and ARDS, as well as mortality, per increase in the number of ribs fractured. With 6 ribs fractured there is a breaking point for significant complications.[41] Symptoms that suggest ARDS include the acute onset of shortness of breath and hypoxaemia leading to acute respiratory failure.
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