History and Physical Examination

The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock.^[6]The presentation depends on the mechanism of injury and the organ systems injured.

Obtaining as detailed a clinical history as possible is extremely important in the assessment of a patient who has sustained blunt thoracic trauma. The time of injury, mechanism of injury, estimates of motor vehicle accident (MVA) velocity and deceleration, and evidence of associated injury to other systems (eg, loss of consciousness) are all salient features of an adequate clinical history. Information should be obtained directly from the patient whenever possible and from other witnesses to the accident if available.

For the purposes of this discussion, blunt thoracic injuries may be divided into the following three broad categories:

Chest-wall fractures, dislocations, and barotrauma (including diaphragmatic injuries)
Blunt injuries of the pleurae, lungs, and aerodigestive tracts
Blunt injuries of the heart, great arteries, veins, and lymphatic vessels

This article presents a concise exegesis of the clinical features of each condition in these categories, which then serves as the basis for outlining indications for medical and surgical therapy for these conditions (see Treatment).

The American Association for the Study of Trauma (AAST) has developed several scales for assessing the severity of injury to organs that may be affected by blunt chest trauma.^{[7, 8]}

Workup

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