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This chapter discusses the diagnosis, evaluation and management of thoracic trauma including pneumothorax, hemothorax, cardiac tamponade, aortic injury, trachebronchial injury and flail chest. Tension pneumothorax presents with hypotension, tachypnea, tachycardia, distended neck veins, diminished or absent breath sounds on the affected side, and tracheal deviation away from the side of injury. Retained hemothorax following tube thoracostomy is a risk factor for infection, and should generally prompt early video assisted thoracic surgery (VATS). Traumatic pericardial tamponade must be treated with immediate surgical thoracotomy to address the cause of the bleeding into the pericardium. The critical patient with aortic injury who survives transport to the emergency department has a high probability of aortic rupture resulting in complete hemodynamic collapse and death if not immediately diagnosed and treated. Tracheal transection is associated with multiple other severe injuries. Endotracheal intubation and mechanical ventilation are indicated for the decompensating patient with flail chest.
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