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Official websites use. Share sensitive information only on official, secure websites. Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods. Trauma is the third leading cause of death in all age groups after cardiovascular diseases and cancer. Chest trauma remains a serious problem as high-speed vehicle accidents increase. Trauma can be divided into two types: penetrating and blunt. Penetrating injuries such as penetrating, cutting and firearm injuries are disruptive to tissue integrity. Blunt injuries can cause damage to organs and structures under the tissue without disrupting the integrity of the tissue. Falling from height, traffic accidents and occupational accidents are main mechanisms of blunt injuries. In the primary survey of chest trauma patients, 6 life-threatening conditions airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, pericardial tamponade should be immediately investigated and treated. The following potentially life-threatening injuries should be immediately investigated: pulmonary contusion, tracheobronchial injuries, diaphragmatic injuries, myocardial injury, thoracic aortic disruption, and esophageal injury. Similarly, 2 of these 6 conditions are pulmonary injuries due to trauma. Although trauma usually involves many tissues and organs, these life-threatening conditions show how important pulmonary injuries are in trauma patients. Chest wall and pulmonary injuries caused by blunt thoracic trauma include many organs, tissues and systems. Therefore, a multidisciplinary approach is needed for these patients. In addition, the age of the patient is important when evaluating a blunt chest trauma. While a trauma in the pediatric age group may not cause a chest wall injury due to bone elasticity, it may lead to serious complications and even death in the elderly population. It also can be interpreted that even if there is a serious trauma in the pediatric age group, the number of fractures may not be high due to bone elasticity, but in the elderly population the number of bone fractures may be high even in a slight trauma. There are many risk factors that affect morbidity and mortality in blunt chest trauma. Despite patient's age, other important variables included the presence of bone fractures and the number of fractures, mechanical ventilation, as well as pre-existing chronic lung diseases, co-existing head injury, hypotension and extra thoracic organ injury. Chest traumas are continuously increasing and many patients with chest trauma die before hospitalization despite using simple treatment methods. The cause of the mortality and morbidity in blunt chest trauma is mostly due to delayed pulmonary complications. So we will examine these injuries that can manifest themselves in many ways. We mentioned that blunt traumas were defined as injuries that organs and structures were injured without disrupting tissue integrity. Blunt traumas can also be classified according to their mechanisms. The mechanism of blunt trauma can be listed as motor vehicle accident, occupational accident and fall. It is important to know the mechanism of blunt injury for a rapid diagnosis and treatment, because there are specific injuries caused by different mechanisms, and the mechanism of injury is an independent factor of mortality. The severity of injury may depend on the strength and duration of the blunt impact as well as the acceleration-deceleration injury and compression damage that occur during trauma. The best example of acceleration-deceleration damage is motor vehicle accident. Most of the blunt thoracic trauma are caused by motor vehicle accidents includes pedestrian accidents and falls from height. It is important to know acceleration-deceleration injury and thoracic compression in blunt chest trauma. Because it will be easier to understand the chest wall and pulmonary injuries caused by these traumas. In a blunt trauma, clinical findings revealed that all structures in the thorax can be damaged, such as chest wall tissues, thoracic cage, ribs, lung, pleura, large vessels, diaphragm, heart and mediastinal structures. Patient history and physical examination may have been pushed to the second plan with the development of imaging methods in medicine. However, patient history and physical examination are still an integral part of the diagnosis. It is true that patient history and physical examination are insufficient for diagnosis of trauma patients, 39 but they form the basis of a holistic approach to diagnosis with imaging methods. Symptoms of patients may contain a lot of valuable information and assist in diagnosis and treatment. Signs and symptoms of thoracic trauma include: cyanosis of fingers, lips or face, dispnea, tachpnea or bradipnea, contusion, laceration, perforations, distension and other specific traumatic findings, hemoptysis, signs of shock hypoperfusion , tracheal deviation, paradoxical movement of the chest wall, distension jugular veins, decreased or absent breathing sounds, pain and especially pain related to respiratory function, failure of chest expansion in normal inspiration. Respiratory distress is a serious problem in individuals with blunt chest trauma. Patients with respiratory distress may breathe with nasal flaring, using accessory muscles, intercostal and subcostal retractions, and signs such as tachypnea. The patient's lungs may not be equally involved in breathing. Paradoxical respiration can be observed and immediate diagnosis of flail chest can be made and thereafter rapid intervention can be performed. In the case of flail chest, it may not always be possible to see paradoxical movement due to pain. But does it always make sense to take X-rays without physical examination, while in some cases where inspection is sufficient for diagnosis? As in all trauma patients, vital signs are one of the best indicators of blunt thoracic trauma. Findings such as tachycardia and hypotension are very valuable. Ecchymoses can be detected and the patient may have a cyanotic appearance. The presence of the Beck Triad distended neck veins, hypotension, muffled heart sounds may indicate cardiac tamponade. Skin color and pulse can provide information about many conditions. Signs such as seatbelt sign or steering wheel deformity are indicators for high-energy blunt thoracic trauma. These signs should be carefully observed by inspection. Blunt thoracic trauma patiens may have tracheal deviation and deformities of the chest wall may be observed. These trauma patients may have multiple tissue contusions and laserations. In addition, these patients may have crepitation, subcutaneous emphysema, and tenderness over the ribs. As a lot of valuable information can be obtained by inspection and palpation, the trauma patient should be examined by removing the clothes. Complaints such as decreased breathing sounds and pleuritic pain may occur. In cases of high mortality such as tension pneumothorax, hyperresonance can be taken in percussion. In contrast, dulness can be taken in hemothorax. The presence of hypovolemic shock findings in the patient while taking dulness in percussion suggests hemothorax. Early diagnosis and treatment are important for the prevention of the mortality and complications in patients with blunt thoracic trauma. For this reason, history and physical examination are an integral part of the approach to these patient. However, it should be noted that some trauma patients may not have these symptoms or may be nonspecific. The most common injury in blunt thoracic trauma is chest wall injury, which also includes rib fractures. When bone fractures are mentioned, not only rib fractures but also clavicle and sternum fractures should be considered. A study of trauma patients by Demirhan et al. According to a study by Brasel et al. Considering that rib fractures were quite common in blunt chest trauma, the importance of mortality rate was understood. Isolated rib fractures are not fatal. However, the rib fractures are usually accompanied by additional damage such as damage of pleura and lung tissue, pneumothorax, hemothorax, pulmonary contusion and parenchymal laceration, etc. The affacted rib usually fractured from the point of blunt impact or from the posterolateral bend, which is the most vulnerable part. The first two ribs are strongly attached to the musculoskelatal system, making them more difficult to break. Fracture of the first ribs is a high risk indicator for tracheobronchial, vascular, cardiac and pulmonary injuries. Middle zone ribs 4 to 9 are heavily exposed to blunt trauma. Rib fractures can cause various injuries and pulmonary complications as well as intraabdominal organ injuries. Although the last two ribs are more mobile and less fractured, fractures may result in liver, spleen and kidney injuries. The number of rib fractures and the age of the trauma patient are the most important indicators of mortality and morbidity. The problem caused by bone fractures in blunt chest trauma is based on three main reasons: hypoventilation due to pain, impaired gas exchange due to parenchymal damage, and alteration of breathing mechanics. Weakened diaphragm and intercostal muscles, decreased muscle mass and loss of alveoli are associated with altered respiratory mechanics in the elderly population. These changes result in decreased lung volume and function, and impaired gas exchange due to reduced respiratory reserve. With these changes, elderly patients with bone fractures have an increased risk of hypoventilation, atelectasis and pneumonia. Patients may also have point tenderness. Decreased lung sounds may also be present. Retention of pulmonary secretions and pneumonia may occur due to pain caused by rib fractures. Compared with young patients, clinical symptoms may appear later in the elderly population. Patients with isolated bone fractures may be reported as minor trauma. However, the incidence of pneumonia and mortality in elderly patients with rib fractures is twice as high as in young patients. Rib fractures are more common in adults than in pediatric group. Because children's ribs are more flexible. Therefore, pulmonary injuries in children may occur without significant injuries to chest wall. In addition, contusion of chest wall tissue is another common problem in blunt trauma. However, contusion and abrasion of chest wall tissue can cause bleeding by injuring vessels in the skin, subcutaneous tissue, and muscles. Although bone fractures are the most common cause of blunt injuries in chest traumas, they may also be a group of patients with various intrathoracic injuries but without bone fractures. This result shows that blunt chest trauma can cause various injuries and impacts without bone fractures. Although an important injury of chest trauma is rib fractures, other bone structures in the thorax should also be considered. Sternal fractures are usually caused by anterior blunt chest trauma of the steering wheel as a result of motor vehicle accidents. Electrocardiography and cardiac enzymes should be evaluated in sternal fractures. Physical examination is insensitive in the diagnosis of bone fractures. With decreasing of inspiratory capacity and clearance of pulmonary secretions, the patients cannot cough because of pain, adequate pain control is important for the elimination of pulmonary secretions. Aggressive pain control is important to prevent atelectasis in patients, to increase the functional residual and vital capacity. Patients should be managed by considering the accompanying injuries and treated with a multidisciplinary approach. Flail chest is a condition in which three or more contiguous ribs are broken at least in two parts. Basically, flail chest occurs when a segment of the chest wall is disconnected from the rest of chest wall. As the flail segment loses its continuity, the chest wall paradoxically moves in different directions during inspiration and expiration. In the inspiration, the ribs move outward while the flail chest moves inward; in the expiration, the opposite occurs. This is called paradoxical motion. Flail chest is often caused by blunt trauma to the thorax, such as direct blows, falls from height, and car accidents. Flail chest is usually not alone, but with additional injuries like extrathoracic organ injuries, shock and blood loss. As a result of parenchymal contusion, the breathing mechanism is impaired and edema and even necrosis may occur with pulmonary tissue bleeding. The presence of pulmonary contusion is highly predictive of morbidity. Flail chest is also closely associated with injuries such as hemothorax and pneumothorax. The main problem in these patients is the parenchymal injury caused by the flail chest, as well as the pain caused by rib fractures worsen the patient's condition. The presence of pain reduces tidal volume and may suppress the cough reflex, leading to atelectasis and pneumonia. Paradoxical motion may not be seen because the breathing is shallow due to pain, therefore, the diagnosis can be difficult. Although patients may have a good clinical appearance, they should be kept under close observation since their condition may deteriorate. Paradoxical respiratory movement is typical for the diagnosis. Patients may also have severe chest pain and signs of respiratory distress, such as tachypnea. It is especially valuable in the diagnosis of blunt injury and parenchymal contusion. Flail chest may occur as a result of bone fractures as well as the separation of the costochondral junction. However, CXR may not show the separation of the costochondral junction. These patients should firstly undergo airway-breathing-circulation ABC procedures. Frequent monitoring of vital signs is important in all trauma patients. Pulmonary physiotherapy, adequate pain control, endotracheal intubation, mechanical ventilation and close follow-up should then be performed. Oxygenation is also important in these patients. Prolonged intubation increases morbidity and mortality by increasing the risk of pneumonia. Open reduction and internal fixation ORIF is also involved in flail chest treatment. Although ORIF is not generally accepted yet, there are data indicating that it shortens the stay in the intensive care unit ICU and reduces the complications if there is indication. It should also be kept in mind that pulmonary contusion is a relative contraindication for ORIF. After the recovery period, flail chest patients may experience long-term disabilities such as dyspnea, chronic pain, exercise intolerance and delay in return to work. Pneumothorax is a clinical entity that is caused by the presence of air between the visceral and the parietal pleura. In short, air trapped between the lung and the chest wall, because the accumulated air in related side of the lung collapsed. Pneumothorax is the most common life-threatening injury in blunt thoracic trauma. It can lead to symptoms ranging from mild chest pain to cardiovascular collapse and death. Pneumothorax can be examined as spontaneous and non-spontaneous Fig. We can define spontaneous pneumothorax as non-traumatic pneumothorax, and these are pneumothoraces that occurs without trauma or in the presence of an underlying precipitating factor. Trauma is the major cause of nonspontaneous pneumothorax. However, it should be kept in mind that iatrogenic causes such as transthoracic needle aspiration, subclavian vein catheterization, thoracentesis, biopsy and mechanical ventilation also bring to pneumothorax. The deterioration of the patient's condition after a medical procedure could suggest iatrogenic causes. Even a very small pneumothorax can lead to hemodynamic instability and severe respiratory failure. Pneumothorax can occur in blunt chest trauma in four mechanisms: 1 alveolar rupture due to increased alveolar pressure, 2 paperbag effect occurs if epiglottis is closed during sudden pressure increase in tracheobronchial tree , 40 3 acceleration-deceleration injury, 4 rib fractures damaging the pleura. In the early period, patients may have chest pain, dyspnea, anxiety, tachypnea, tachycardia and hyperrezonance and decreased respiratory sounds on the pneumothorax side. In tension pneumothorax, air enters the pleural space at each inspiration, while the air in the pleural space cannot escape from the pleural space due to the one-way valve mechanism. Due to the continuous accumulation of air in the pleura, the lung collapses, hypoxia becomes severe, and hypotension occurs. It also affects the other lung by sliding to the opposite side and causing cardiovascular collapse. In pneumothorax, the patient may have tachypnea and tachycardia, hyperresonance can be obtained in percussion and tracheal deviation may be seen in late phase. Clinical findings and physical examination are very valuable for diagnosis of pneumothoraces. CT is the most effective method in the diagnosis of pneumothorax. However, in some pneumothoraces, air in the pleural cavity may not be visible on CXR. Occult pneumothoracis OPTX is an example of this type of pneumothorax. CXR cannot diagnose more than half of pneumothorax cases. The method of ultrasound evaluation of the lung is now becoming widely used. Imaging methods such as CXR and CT may cause problems in polytrauma patients and especially in cases requiring spinal immobilization. According to the study of Blaivas et al. Also ultrasound is not invasive and the patient is not exposed to radiation. Pneumothorax treatment requires a holistic approach including monitoring, resting, oxygen supply and tube thoracostomy. Treatment should begin with the principles of ABC approach to the trauma patient. The patient's airway continuity, breathing and circulation should be monitored repeatedly. Advanced trauma life support recommends tube thoracostomy for all traumatic pneumothorax cases due to the risk of tension pneumothorax. General principles such as air elimination, reducing air leakage, healing pleural fistula, promoting re-expand and preventing future recurrances are applied in the treatment of pneumothorax. Thoracotomy for pleurodesis or video assisted thoracoscopic surgery VATS may be used in more advanced cases. Hemothorax and hemopneumothorax occur in almost one in three trauma patients with thoracic injuries. According to the study by Liman et al. According to some medical literature, the presence of three or more rib fractures is inevitable for hemothorax. As a result of hemothorax, hypovolemia symptoms may occur in patients due to blood loss. It should be noted that up to 6 L blood can accumulate in the pleural space. At the same time, hemothorax can cause atelectasis in the lungs and cause respiratory distress. Flattening of the neck veins, hypotension, tachycardia, decreased breathing sound, dullness in the percussion examination of the injured area should suggest hemothorax. Complications such as pneumonia, retained hemothorax, empyema, fibrothorax, respiratory distress may occur as a result of hemothorax. As it can be seen, the condition called hemothorax is life-threatening not only with pulmonary events, but in many other ways. As a result, it is necessary to remember the other complications caused by blunt trauma besides hemothorax. In hemothorax, the condition called retained hemothorax may arise due to inability to perform early tube thoracostomy, insufficient drainage or iatrogenic reasons due to interventions. A retained clot in the pleural space as a result of hemothorax is a primary predisposing factor for post-traumatic empyma. The only source of microorganisms that cause post-traumatic infections is not airways but also tube thoracostomy. In addition, in minor trauma patients, the hemothorax cannot be detected at first, but may occur after a while, which is called delayed hemothorax. The incidence of delayed hemothorax in the first 2 weeks was 7. Due to the risk of delayed hemothorax and pneumothorax, all discharged patients need to be recalled after 2 weeks. It is essential to start with physical examination in the diagnosis of hemothorax. In a study by Bokhari et al. The blunting of the costophrenic angle or partial or complete opacities in the hemithorax may suggest hemothorax. In addition, the use of ultrasound has become more common in recent years, because it is very useful for nonstable patients who cannot take CT. The use of ultrasound can also prevent unnecessary tube thoracostomy and reduce the related complications. One of the most important steps in the management of hemothorax is early intervention. Because blood loss can be severe enough to cause sudden vascular collapse. It is noteworthy that patients with massive hemothorax caused by large vessels often die before being hospitalized. The aim of tube thoracostomy are 1 to clear the pleural space as much as possible 2 to provide re-expansion of the lungs 3 to create a buffer effect by contacting the lung with the parietal pleura 4 to measure the amount of blood lost and 5 to reduce the risk of complications such as empyema and fibrothorax. In addition, there are studies showing that it is an effective method to monitorize and observe the patient instead of tube thoracostomy in smaller hemothorax, yet a consensus has not been reached on this subject. VATS is an effective method in cases of inadequate drainage and retained hemothorax. In the study conducted by Lin et al. If the patient has massive hemothorax, i. Fibrinolytic agents may also be used in therapy. Although fibrinolytic agents are used in combination with tube thoracostomy, studies on this subject are insufficient. Pulmonary contusion is defined as pulmonary destruction with alveolar hemorrhage, which usually occurs as a result of blunt chest trauma without laceration. Pulmonary contusion occurs when kinetic energy is transmitted to the lung parenchyma. Bleeding and edema cause serious changes in the lung tissue. Pulmonary contusion can often coexist with the flail chest, and most such patients suffer from dyspnea, decreased exercise tolerance, and chest pain on the side of the injury. Classically, CXR is the first modality for imaging diagnosis. Focal or diffuse homogeneous opacification is the basis of diagnosis on chest radiography. However, contusion may not be seen in one or more of the three patients by CXR. The recovery of a noncomplex pulmonary contusion may be observed on CXR between 48 h and 72 h, but complete recovery may take up to 14 days. Clinically, chest pain, dyspnea and tachypnea may be present. Hypoxemia and hypercarbia may occur, especially due to contusion associated with other injuries. Even if the presence of contusion appears in CXR or CT, the clinical condition varies from asymptomatic to respiratory compromise. The treatment logic of pulmonary contusion is supportive therapy. Supportive methods such as frequent follow-up of vital signs, oxygen support, pain control, early mobilization and chest physiotherapy are used in patients. It is also very important to protect euvolemia in cases of pulmonary contusion. Abnormal fluid accumulation in the interstitial and intraalveolar space is the most important pathology of pulmonary contusion. Furthermore, pharmacological treatments are insufficient for the treatment of pulmonary contusion. Steroid and empirical antibiotic use are still controversial. Pulmonary laceration is the injury that occurs in the parenchymal tissue of the lung. In contrast, parenchymal structure is intact in pulmonary contusion. Pulmonary lacerations can be divided into four subtypes. Type 2: lacerations are caused by compression and occur in the lower lobes and paraspinal region. Type 3: lacerations are usually seen as a result of pleural puncture of rib fractures and are associated with pneumothorax. Type 4: lacerations are caused by rupture of pleural adhesions and have no characteristic radiological findings. Since bone elasticity is high in the pediatric group, pulmonary laceration may occur without bone fracture, similar to pulmonary contusion. Lacerations not only cause bleeding and respiratory distress. Pulmonary lacerations also cause air leakage and this is the most common cause of pneumothorax in blunt traumas. Pneumatocele may develop if air enters pulmonary cavities, and hemato-pneumatocele may occur if both air and blood are involved. Like all trauma patients, a complete physical examination should be performed and lung sounds should be listened bilaterally in patients with suspected pulmonary laceration. Respiratory sounds may be decrased on the side of pulmonary laceration. It is difficult to detect pulmonary lacerations with CXR. Because pulmonary lacerations usually overlap with concomitant pulmonary contusions. The severity of pulmonary laceration is various and the treatment should be shaped accordingly. Hemodynamic instability due to bleeding should be prevented and appropriate fluid resuscitation should be performed. Supportive treatment should be applied and chest tube should be used if necessary. Surgical interventions may be necessary if bleeding cannot be controlled. Pulmonary lacerations heal later than contusions and may last for several months. Tracheobronchial injury is the injury to the trachea, bronchi and tracheobronchial tree. Although tracheobronchial injury is rare, it is the most severe form of chest trauma and has a fatal course. The incidence of tracheobronchial injury ranges from 0. Tracheobronchial injury occurs through three mechanisms : 1 a sudden anterior to posterior force above the carina level, 2 severe compression injury with the glottis closed, and 3 tear of cricoid and carina adhesions of the trachea in a rapid deceleration. Diagnosis of tracheobronchial injury is very difficult. The majority of patients with tracheobronchial injury cannot be confirmed immediately. The first imaging modality for the diagnosis of tracheobronchial injury is CXR, but CXR is not sufficient and there are no specific findings. Although tracheobronchial injuries cause severe respiratory distress in patients, positive pressure ventilation is contraindicated in tracheobronchial injury because it may exacerbate the condition. The main logic of treatment in tracheobronchial injury is to maintain airway continuity and to repair the injury. If necessary, tracheostomy or cricotomy can be performed to ensure airway continuity. Treatment methods such as fibrin glue may also be used, but are not generally accepted. We mentioned in the introduction that trauma was the leading cause of death in age of first four decades of life. Rapid diagnosis and treatment of trauma, including blunt chest trauma, is more important than other cases. The principles of approach to trauma patients should always be applied. In primary survey, airway, breathing, circulation, disability, exposure ABCDE approach should be performed. Head injury and hemorrhage are the major causes of early death in all trauma patients. The rate, depth and pattern of respiration are also important. In addition, airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest and cardiac tamponade, which are the six mortal conditions that can be seen in a chest trauma, must be detected at the primary survey. After the ABCDE principles, the injury severity should be evaluated by considering vital signs, mechanism of injury, patient complaints, and general clinical presentation. History and physical examination is essential to quickly detect major injuries such as tension pneumothorax, massive hemothorax and flail chest. In physical examination, an asymmetry in the chest should be examined, palpation should be performed to detect crepitation and auscultation should not be omitted. Although physical examination is considered to be insufficient for diagnosis most time, it is still valuable and necessary. Contrary to popular idea, physical examination has a very high sensitivity and specificity, especially in the diagnosis of hemopneumothorax. Even if patients do not have serious symptoms, they should be followed up for 2 weeks after the trauma, because of the risk of complications such as delayed hemothorax, delayed pneumothorax and OPTX. Hemorrhage may occur due to various injuries in blunt traumas and it may be difficult to diagnose them. Bleeding is the most common cause of shock in trauma patients. The presence of prehospital hypotension is indicative of serious damage. Management in patients with blunt chest trauma is mainly provided by early mobilization, adequate pain control, proper fluid resuscitation, and appropriate respiratory support. Pulmonary contusion as a result of blunt chest trauma is usually represented as respiratory failure. Rib fractures may also disrupt the physiological structure of the chest wall and lead to respiratory failure. Respiratory failure may be due to direct pulmonary injuries caused by blunt chest trauma or indirectly due to traumatic brain injury. In this instance, it should be kept in mind that the patient's respiratory distress may be due to brain damage. However, mechanical ventilation increases mortality. Early noninvasive ventilation may reduce the need for intubation. CXR is the primary diagnostic tool for detecting injuries resulting from thoracic trauma, but CT is more sensitive. Monitoring of vital signs should be done frequently and treatment should be performed to prevent from complications. It should be noted that patients with blunt chest trauma are usually a polytrauma patient and should take a holistic approach. Acidosis and hypoxia may also occur in a trauma patient. The presence of hypovolemia and vascular collapse in the trauma patient is associated with mortality so it is important to be noticed. Therefore, appropriate volume resuscitation and acidosis treatment is very important in trauma patients. Conditions such as pneumothorax and pulmonary contusion require oxygen support to the patients. In addition, patients should receive pulmonary physiotherapy such as deep breathing exercises, aerosol therapy, active cough maneuvers and incentive spirometry. Analgesics with pulmonary physiotherapy are important for the prevention of complications such as pneumonia and atelectasis in patients. If necessary, specific treatments such as needle decompression, tube thoracostomy, and thoracotomy should be performed. According to the International Association for the Study of Pain, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. The presence of pain may impair the ability of the person to breathe, impairing ventilatory function, further exacerbating impaired lung mechanics caused by inflammation and possible contusion already present in a blunt trauma patient. In addition, it causes the retention of pulmonary secretions which further suppresses the patient's cough reflex. Therefore, the cough reflex suppressed by pain leads to atelectasis and increases morbidity. Accordingly, if a patient with lung injury is not treated appropriately and an appropriate analgesia is not performed, the present systemic inflammation results in decreased lung compliance, ventilation-perfusion mismatch, hypoxemia and respiratory distress, respectively. Nonsteroidal anti-inflammatory drugs NSAIDs , systemic opioids or regional analgesia methods such as epidural analgesia, intrapleural analgesia, intercostal nerve block, and thoracic paravertebral block can be used for pain control. Multimodal methods e. The advantage of epidural analgesia over systemic opioids is that they are non-sedating, and patients can perform pulmonary physiotherapy more appropriately because they are awake. Intrapleural analgesia is performed by applying local anesthetic agent to the pleural space and does not cause hypotension. All methods have advantages and disadvantages, there is no perfect one. Therefore, the clinician should choose the most appropriate method according to the patient's condition, contraindications, side effects and severity of trauma. Even effective analgesia is affected by factors such as the patient's ethnicity and anxiety. Inadequate pain control can make the patients to experience posttraumatic stress and chronic pain. Morbidity and mortality in blunt chest trauma are common in the community. However, it should be kept in mind that every chest trauma patient may also be a polytrauma patient and the accompanying injuries should be examined carefully. Therefore, history and physical examination should not be missed, imaging methods should be used appropriately, and the patient should be treated with rapid diagnosis and treatment. In addition, the long-term outcome of trauma patients should be taken into account, complications should be prevented and pain should be managed. Therefore, management of the trauma patient is a long-term and holistic approach including prehospital management, emergency care, intensive care unite and post-injury period. Since surgical intervention in blunt chest trauma is required in a small number of patients, many patients can be treated with conservative methods or simple procedures such as tube thoracostomy. Trauma and blunt chest injuries are also serious psychosocioeconomic problem worldwide. Patients with chest trauma should be treated not only for pulmonary and non-pulmonary injuries, but also for psychological effects, which may delay return to work as well. This article does not contain any studies with human participants or animals performed by any of the authors. As a library, NLM provides access to scientific literature. Chin J Traumatol. Find articles by Bekir Nihat Dogrul. Find articles by Ibrahim Kiliccalan. Find articles by Ekrem Samet Asci. Find articles by Selim Can Peker. Production and hosting by Elsevier B. Open in a new tab. Peer review under responsibility of Chinese Medical Association. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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