Blunt chest
trauma is the leading cause of
thoracic injuries in Germany, 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 consists of detection and sufficient
therapy of acute life threatening situations like
tension pneumothorax, acute
respiratory insufficiency or severe intrathoracic
bleeding. Most of the isolated
thoracic injuries are adequately treated by conservative means, sufficient
analgesia, drainage of intrapleural air or blood, physiotherapy and clearance of bronchial 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 significant increase of morbidity and mortality. Hence, patients with this combination of
pulmonary injuries, such as lung
contusion and associated severe
injuries, carry a particular high risk of
respiratory failure, 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 and supine positioning of multiple injured patients with lung
contusion and differentiated concepts of volume- and
catecholamine therapy represent the basic therapeutic principles. Additionally, the entire early
trauma management of multiple injured patients must focus on the presence of pulmonary
contusion. Every additional burden on their pulmonary microvascular system like microembolisation during femoral nailing, the
trauma burden of extended surgery or mediator release in septic states may cause rapid decompensation and organ failure and therefore, has to be avoided.