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Blunt Chest Trauma

Thoracic trauma accounts for 25% of all trauma fatalities. Blunt trauma mortality is high because it is often associated with multi-system injuries.

Types of pulmonary injuries include pulmonary contusion,
pneumothorax, hemothorax, and pneumomediastinum.


Chest wall injuries may also occur with blunt chest trauma. These injuries include rib fractures, flail chest,


tracheobronchial disruption and diaphragmatic rupture. Most cardiac injury due to blunt chest trauma involves compression of the vertebral column. The right ventricle is the most frequently injured chamber due to its position. Life-threatening emergencies following blunt chest trauma require accurate assessments and rapid interventions to prevent unnecessary complications and death. The major objective in the initial management of these patients is to restore normal cardiopulmonary function. This is accomplished by establishing an adequate airway and ventilation, and correction of hypovolemia or low cardiac output.

Differential Lung Ventilation

Differential lung ventilation (DLV) requires a double-lumen endotracheal tube and two ventilators set to cycle in sync. One ventilator acts as the primary ventilator and the other as the secondary ventilator. DLV is usually begun by applying equal tidal volumes to each lung while monitoring airway pressures. If airway pressures are too high, the tidal volume in the less compliant lung is adjusted downward while shifting volume to the other lung in an attempt to avoid barotrauma. PEEP is then applied in inversely proportional amounts to lung compliance to equalize the functional residual capacity of each lung.

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