Objectives

1. Understand the pathophysiology and treatment of trauma to the heart and great vessels.

2. Understand the pathology and treatment of trauma to the lungs and thoracic wall.

3. Understand trauma to the larynx, trachea, and bronchial tree.

4. Understand the anesthetic implications of all of the above pathologies.

INTRODUCTION

Trauma is one of the leading causes of death in the world. Thoracic trauma, particularly to the heart or great vessels, accounts for 20–25 percent of the trauma mortality. Although most significant injuries to the cardiac or great vessel structures are immediately fatal, some very common traumatic clinical scenarios can result in excellent outcomes with appropriate diagnosis and rapid institution of treatment [1]. Hypovolemia has been implicated as a primary factor in traumatic fatalities, [1] a clinical problem that is integral to an anesthesiologist's resuscitative attempts. When compared with out-of-hospital cardiopulmonary arrest, survival following traumatic cardiopulmonary arrest may be similar [1] and reversible problems should be considered. It is imperative that anesthesiologists understand trauma of the heart and great vessels so that appropriate and expeditious care can be provided. Supplemental material can be accessed via the Internet at the Web sites shown in Table 18.1 (see also Chapter 17).

CARDIOTHORACIC ANATOMY

The thorax contains vital organs and vasculature that are protected by the bone structure of the vertebral column, sternum, and ribs. Inferiorly the thorax is demarcated by the diaphragm, whereas the structures of the neck and lung apices are found superiorly.