Chest Trauma

Rule out immediate life-threats

Red flags
  • Tension pneumo, massive haemothorax (>1.5 L or >200 mL/h)
  • Cardiac tamponade
  • Flail chest with pulmonary contusion
  • Aortic injury

First steps

  • ABCDE + high-flow O₂
  • Bilateral chest exam + FAST scan + eFAST
  • Chest drain if pneumo/haemo

Key investigations

  • CXR, eFAST, CT chest (with angio if aortic concern)
  • ABG, troponin

Differentials

  • Blunt cardiac injury
  • Diaphragmatic rupture

Initial management

  • Tension pneumo → needle decompression
  • Massive haemothorax → 32-36 F chest drain, autotransfusion
  • Aortic transection → cardiothoracic surgery/TEVAR
  • Flail chest → analgesia + NIV, surgical fixation if severe

Referral

  • Cardiothoracic surgery
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