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R E F R E S H E R C O U R S E O U T L I N E R29
Blunt thoracic trauma:
anaesthesia, assessment
J. Hugh Devitt MDFRCPC and management
Patients presenting with major and multiple injuries re- contusion, diaphragmatic rupture, cardiac and aortic in-
quiting emergency surgery are a great challenge to the juries. However, several injuries had a greater frequency
anaesthetist. If one has limited experience in managing with the higher speed limit. These included haemothorax,
the polytraumatized, learning of the impending arrival sternal fracture, tracheobronchial rupture and flail chest.
of a patient with blunt thoracic trauma often leads to Patients injured at the higher speed limit had a greater
a high level of anxiety. This concern may be misplaced. length of hospitalization, a greater need for mechanical
The causes of perioperative morbidity and mortality in ventilatory support and a larger chest tube drainage. 7
patients with blunt thoracic trauma are airway obstruc-
tion, respiratory failure and haemorrhage. The anaesthe- Mortality
tist is ideally suited and trained to deal with these prob- The overall mortality of patients with blunt chest trauma
lems. ranges from 11.9to 17.3%in adults and 8% in children. 3-9
Intraoperative mortality for patients with blunt thoracic
Nature of the problem trauma requiring emergency surgery within 24 hr
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