Chest Wounds, Penetrating
Depending on their size, penetrating chest wounds may cause varying degrees of damage to bones, soft tissue, blood vessels, and nerves. Mortality and morbidity from a chest wound depend on the size and severity of the wound.
Gunshot wounds are usually more serious than stab wounds, both because they cause more severe lacerations and cause rapid blood loss and because ricochet often damages large areas and multiple organs. With prompt, aggressive treatment, up to 90% of patients with penetrating chest wounds recover.
Stab wounds from a knife or ice pick are the most common penetrating chest wounds; gunshot wounds are a close second. Wartime explosions or firearms fired at close range are the usual source of large, gaping wounds.
Signs and symptoms
In addition to the obvious chest injuries, penetrating chest wounds can also cause the following:
Penetrating chest wounds may also cause lung lacerations (bleeding and substantial air leakage through the chest tube), arterial lacerations (loss of more than 100 ml of blood/hour through the chest tube), and exsanguination. Pneumothorax (air in the pleural space causing loss of negative intrathoracic pressure and lung collapse), tension pneumothorax (intrapleural air accumulation causing potentially fatal mediastinal shift), and hemothorax can also result.Other effects may include arrhythmias, cardiac tamponade, mediastinitis, subcutaneous emphysema, esophageal perforation, and bronchopleural fistula. Tracheobronchial, abdominal, or diaphragmatic injuries can also occur.
An obvious chest wound and a sucking sound during breathing confirm the diagnosis. Consider any lower thoracic chest injury a thoracicoabdominal injury until proven otherwise.
Further tests to provide baseline data include:
Penetrating chest wounds require immediate support of respiration and circulation, prompt surgical repair, and measures to prevent complications.
In case of penetrating wounds, these require attention, but generally only after the airway has been secured and a chest drain inserted. Supportive therapy may include mechanical ventilation .
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