Thoracic Injuries

Thoracic trauma is a significant source of morbidity and mortality in both the civilian and military settings. Retrospective series on modern conflicts report an increased incidence of thoracic combat injuries, many of which are caused by blast events. Although most thoracic injuries can be managed non-operatively, blast injuries more often require some combination of operative management and/or critical care management because of the complex injury patterns and respiratory compromise that results. As with all blast injuries, the exact pattern of thoracic injury following a blast event depends upon the distance between the blast and the casualty as well as the protective equipment in place. Classic patterns of injury include the “batwing” perihilar contusions from primary blast injury and the large chest wall defects from secondary blast injury. This chapter describes in detail the various forms of thoracic blast injury and the recommended management in the trauma bay, the operating room, and the intensive care unit.