The Chest: Indication and Techniques for Trauma Exploration

Thoracic trauma continues to cause at least 25% of traumatic deaths in the USA, and many of these injuries cause death within the first minutes to hours following trauma. Mortality of thoracic injuries is second only to head injuries. Many deaths are preventable by prompt diagnosis and treatment given the vital structures that reside within the thoracic cavity. Injuries from chest trauma range from rib fractures requiring only pain control to cardiac lacerations with tamponade or exsanguinating hemorrhage. Given the range of injuries, acuity and clinical presentation, multiple diagnostic modalities, and treatment options exist for thoracic trauma. Thoracoscopic techniques have evolved from simple cavity washout through an existing chest tube site with evaluation of diaphragmatic injury to the currently used video-assisted thoracic surgery (VATS). Management of critical injuries by means of sternotomy or thoracotomy remains valuable procedures.