Blunt thoracic trauma

The restructuring of emergency healthcare services has led to more blunt thoracic trauma being treated by a multidisciplinary team, including general, orthopaedic and trauma surgeons, often without immediate access to a thoracic surgeon. Having a critical mass of injured patients in a central location, it has been possible to bring expertise from other areas of intensive care, radiology and surgery and apply new technology and techniques to the trauma patient. We now see the regular use of endovascular stenting and embolization reducing the need for urgent surgery on unstable patients and the increasing use of extracorporeal membranous oxygenation (ECMO) to salvage patients with acute respiratory distress syndrome. A more liberal use of video-assisted thoracic surgery (thoracoscopic) decortication and chest wall fixation both reduce ICU requirements and shorten hospital stay. It is hoped that these improvements in the hospital management of chest injuries will not only improve survival, but that the reduction in the late sequelae of chronic pain and loss of stamina will translate into improved return-to-work rates.