开放性胸部外伤及连枷胸.pdfVIP

Open Chest Wounds and Flail Chest 25 Jacob J. Glaser and Carlos J. Rodriguez 25.1 Background (Fig. 25.1 ). This allows equilibration of pressure between the pleural space and the atmosphere, causing the lung to col- Thoracic injuries are commonly associated with penetrating lapse and leading to profound hypoventilation and hypoxia. and blunt abdominal trauma and are implicated in 50–70 % Flail chest results from high-energy blunt, crushing chest of trauma deaths [1 ]. Cardiac tamponade, tension pneumo- trauma causing two or more fractures in two or more con- thorax, massive hemothorax, airway obstruction, fl ail chest, tiguous ribs. Classically, the fractures are lateral or sternal. and open pneumothorax represent the six immediately life- Posterior rib fractures rarely cause fl ail physiology threatening injuries attributed to chest trauma [2 ]. (Fig. 25.2 ). Flail chest has been reported to have mortality as Accordingly, they must be accurately identifi ed and dealt high as 16 % [4 ]. This injury pattern is associated with a high with urgently. incidence of underlying pneumothorax, hemothorax, pulmo- Open pneumothorax (“sucking” chest wound) is seen in nary contusion, and chest wall instability. Mortality from penetrating chest injuries. If the associated chest wound is fl ail chest is thought to be correlated with the degree of greater than 2/3 the diameter of the trachea (generally any- underlying pulmonary contusion and attendant