Penetrating Chest Trauma

Penetrating chest trauma (PCT) is typically a result of a stab wound or gunshot wound but may also be the result of impalement injuries. The chest is defined as the torso cephalad to the costal margin and contains vital structures including the heart, great vessels, and lungs. Patients with penetrating wounds to the chest should be transported immediately to a trauma center due to concern for injury to any of these vital structures and major vascular or cardiac injury. Rapid evaluation of patients with penetrating chest trauma using advanced trauma life support (ATLS) protocol is essential to identify and treat suspected injuries. A combination of anatomical evaluation, chest x-ray, placement of tube thoracostomy, and focused assessment with sonography in trauma (FAST) exam is essential in the rapid management of these injuries. Adjuncts to these procedures and exams include evaluation of the aerodigestive system with esophagogastroduodenoscopy (EGD) and bronchoscopy once life-threatening bleeding and decompression of pneumothoraces and hemothoraces have been treated. In the following algorithm, we recommend a systematic approach as set forth by the Western Trauma Association to patients who sustain these major, life-threatening injuries. While this algorithm is based on the most recent recommendations, it serves as a framework with which to evaluate and treat patients with these injuries. However, one must use clinical judgment based on each individual patient to ensure the most appropriate treatment in an effort to maximize survival.