Penetrating Chest Trauma Clinical Presentation

Updated: Nov 20, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Jeffrey C Milliken, MD  more...
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Presentation

History and Physical Examination

Admission history and physical examination are usually brief and are oriented to the injury. Evaluations of vital signs, consciousness, airway competency, vascular integrity, and pump (cardiac) function are rapidly performed before devoting attention to the point of injury. If the patient is stable and no significant injury is found that requires immediate surgery, a full diagnostic evaluation can be performed (see Workup).

Any entry wound below the nipples (front) and the inferior scapular angles (dorsum) should be considered an entry point for a course that may have carried the missile into the abdominal cavity.

Missiles from gunshot wounds (GSWs) can penetrate all body regions regardless of the point of entry. Any patient with a gunshot entry wound for which a corresponding exit wound cannot be identified should be considered to have a retained projectile, which could embolize to the central or distal vasculature.

A patient with combined intrathoracic and intra-abdominal wounds has a markedly greater chance of dying.

For information on treating penetrating abdominal wounds, see Abdominal Stab Wound Exploration.