Care of the Multiple Injured Patient with Thoracic Trauma

The multiple injured patient with thoracic trauma may pose a difficult challenge to the surgeon. Although the majority of chest injuries (85%) can be managed non-operatively, the presence of these injuries complicates the evaluation and treatment of concurrent extrathoracic trauma. The principles of Advanced Trauma Life Support (ATLS) published by the American College of Surgeons Committee on Trauma, combined with new insight into the concepts of deranged metabolism and physiologic exhaustion, can help one formulate a strategy for prioritizing diagnostic studies, optimizing resuscitative efforts, and conducting appropriate early definitive management. Our principal goal is to avoid prolonged shock by ensuring adequate oxygen delivery and circulating blood volume, and thereby, prevent secondary organ insults. Ideally, during these maneuvers, the physiologic stress response should be blunted with appropriate analgesics and/or sedation. Reduction and immobilization of skeletal trauma also serves to reduce physiologic stress and prevent complications. By outlining the goals of treatment for commonly encountered concomitant injuries, we hope to illustrate how these principles can be integrated for decision-making on the management of patients with serious thoracic trauma.