Chest trauma and blunt cardiac injury in ICU

Also known as Chest trauma · Blunt cardiac injury · Cardiac contusion · Flail chest · Pulmonary contusion · Traumatic aortic injury · Thoracic trauma

Chest trauma: blunt (motor vehicle crash, fall, crush — most) or penetrating (stab, gunshot). ICU-relevant: (1) FLAIL CHEST — ≥3 consecutive ribs fractured in ≥2 places → paradoxical chest wall movement → respiratory failure. (2) PULMONARY CONTUSION — lung parenchymal injury → alveolar haemorrhage/oedema → hypoxia, evolves over the first 24-72 h (peak ~72 h). (3) BLUNT CARDIAC INJURY (BCI) — myocardial contusion → arrhythmia, troponin elevation, rarely cardiac rupture/failure; EAST screening = ECG + troponin I. (4) TRAUMATIC AORTIC INJURY — deceleration → aortic transection (most die at scene, survivors need urgent repair). (5) TENSION PNEUMOTHORAX/HAEMOTHORAX — life-threatening, needle decompression/chest drain. Management: ABCDE, analgesia (epidural/paravertebral for rib fractures), lung-protective ventilation if needed (flail chest/pulmonary contusion), chest drains for pneumo/haemothorax, surgical fixation of flail chest (controversial).

high31 referencesUpdated 26 July 202633 min readVerification in progress

Practise this topic

8 MCQs

^[10]

Key chest trauma injuries

Injury	Mechanism	Key features	Management
Flail chest	≥3 consecutive ribs fractured in ≥2 places	Paradoxical chest wall movement, severe pain, respiratory failure	Analgesia (epidural), ventilation if respiratory failure, surgical fixation (selected)
Pulmonary contusion	Direct impact → alveolar haemorrhage	Hypoxia WORSENS 24-48h, diffuse infiltrates	Oxygen, lung-protective ventilation if severe, avoid fluid overload
Blunt cardiac injury	Direct impact to heart	Troponin elevated, arrhythmia (AF, VT, heart block), rarely pump failure	ECG monitoring 24-48h, troponin, echo, treat arrhythmia
Traumatic aortic injury	Deceleration → aortic transection	Widened mediastinum, haemothorax, BP differential	CT angiography → TEVAR (endovascular) or open repair
Tension pneumothorax	Air under pressure in pleura	Hypotension, tracheal deviation, absent breath sounds	IMMEDIATE needle decompression (2nd ICS MCL), then chest drain
Haemothorax	Bleeding into pleural space	Dullness, decreased breath sounds, hypovolaemia	Chest drain (large bore), thoracotomy for massive initial drainage or ongoing bleeding

^[5]

ICU management of severe chest trauma

PRIMARY SURVEY (ABCDE) — airway (cervical spine control), breathing (oxygen, assess for tension pneumo/haemothorax — needle decompress if needed), circulation (IV access, fluids/blood — control bleeding), disability (GCS), exposure
IMAGING — CXR (pneumothorax, haemothorax, rib fractures, widened mediastinum, pulmonary contusion). CT chest (definitive — CT is highly sensitive for pulmonary contusion and predicts the need for intubation; also aortic injury, sternal fracture, spine). FAST/CT abdomen (multi-system injury is common — in a nationwide sternal-fracture cohort, rib fractures co-existed in 51%, spinal fractures 36%, lung contusion 18%)
RIB FRACTURES — ANALGESIA is KEY — (a) Epidural or paravertebral block (BEST — allows deep breathing/coughing). (b) PCA morphine/fentanyl. (c) Paracetamol, NSAIDs (if no contraindication). Poor analgesia → splinting → atelectasis → pneumonia. Elderly with rib fractures: HIGH mortality — in a modern geriatric (≥65) cohort mortality was 9% overall, 20.6% with over 6 rib fractures, rising further with each additional fracture beyond six
PULMONARY CONTUSION — monitor for deterioration over the first 24-72 h — (a) Serial CXR/CT (worsening infiltrates; symptoms typically peak at about 72 h and resolve within about 7 days). (b) Oxygen (HFNC if moderate). (c) Intubate for progressive respiratory failure: refractory hypoxaemia, exhaustion, rising PaCO2. (d) Lung-protective ventilation (low tidal volumes, plateau-pressure limitation). (e) CONSERVATIVE FLUIDS (avoid overload — worsens contusion)
BLUNT CARDIAC INJURY — ECG + troponin I (EAST) — (a) Admission ECG AND troponin I for every patient with suspected BCI — ECG ALONE is not sufficient to rule out BCI. (b) BCI is ruled out only if BOTH ECG and troponin I are normal. (c) New ECG changes and/or elevated troponin → admit for continuous cardiac monitoring. (d) Echocardiography is NOT a screening tool — reserve for hypotension and/or arrhythmia. (e) Treat arrhythmia per ACLS
SURGICAL — (a) Chest drain (pneumothorax/haemothorax). (b) Thoracotomy (massive initial haemothorax drainage or ongoing bleeding — operative thresholds are well defined in the literature — great vessel injury, tracheobronchial injury). (c) TEVAR (traumatic aortic injury — endovascular stent graft — SVS guideline data show lower mortality than open repair: 9% vs 19%, and 46% with nonoperative management). (d) Surgical rib fixation (flail chest — selected)

^[1] ^[3] ^[25] ^[30] ^[10]

SAQ — Severe blunt chest trauma with pulmonary contusion and BCI

10 minutes · 10 marks

A 62-year-old man (60 kg) is admitted after a high-speed motor vehicle crash in which he struck the steering wheel. Initial GCS 15, RR 28, SpO₂ 90% on 15 L O₂, BP 105/68, HR 110 (sinus), ST elevation of 1 mm in V2–V4 on ECG, troponin 0.4 μg/L, CXR with patchy opacification in the right mid-zone. He has right-sided rib fractures 4–7. CT chest confirms right pulmonary contusion and possible myocardial contusion.

^[3] ^[25] ^[30]

SAQ — Traumatic aortic injury — beta-blocker first

10 minutes · 10 marks

A 35-year-old man is admitted after a high-speed motorcycle crash with a steering-wheel-like handlebar impact to the chest. GCS 15, BP 165/95, HR 122, RR 26, SpO₂ 96%. Contrast-enhanced CT chest shows a peri-aortic haematoma at the isthmus with intimal flap and pseudoaneurysm consistent with a grade III blunt thoracic aortic injury (BTAI).

^[5] ^[29]

Clinical pearls

High-yield chest trauma points for CICM/FFICM exam

Pulmonary contusion WORSENS over the first 24-72 hours. Initial CXR may be NORMAL (or minimal changes). Physiologic consequences manifest within hours; symptoms (respiratory distress with hypoxaemia and hypercarbia) typically PEAK at about 72 h and resolve over approximately 7 days: progressive infiltrates (alveolar haemorrhage + oedema) → hypoxia → may need intubation. MONITOR: serial CXR, SpO2, ABG. DON'T be reassured by normal early CXR. CT is highly sensitive for contusion and highly predictive of the need for subsequent intubation.^[25]
Rib fractures in elderly = HIGH mortality. In a modern geriatric (≥65) cohort, mortality after rib fracture was 9% overall — 7% with ≤6 fractures but 20.6% with over 6 fractures — with odds of death rising 16% for each additional fracture beyond six, 5.6% for each additional year of age, and DOUBLING with pulmonary contusion or bilateral fractures (from pneumonia, respiratory failure). KEY: AGGRESSIVE analgesia (epidural/paravertebral), early mobilisation, pulmonary physiotherapy, monitor in ICU/HDU (even if initially stable).^[30]
Blunt cardiac injury (BCI) — ECG PLUS troponin I is the screening test (EAST 2012). (a) Admission ECG AND troponin I for every patient with suspected BCI — ECG ALONE is not sufficient to rule out BCI. (b) BCI is ruled out only if BOTH ECG and troponin I are normal (adding troponin I to ECG improved negative predictive value to 100% in pooled studies). (c) New ECG changes and/or elevated troponin → admit for continuous cardiac monitoring. (d) Echocardiography is NOT a screening tool — reserved for hypotension and/or arrhythmias. (e) MOST BCI: arrhythmia (AF, PVCs, heart block) — self-limited. Rare: cardiac rupture (tamponade — fatal), severe pump failure (cardiogenic shock).^[3]
Conservative fluid management in pulmonary contusion. Aggressive fluid resuscitation → increased pulmonary capillary pressure → WORSEN contusion (more oedema, more hypoxia). Use: MINIMUM fluid to maintain perfusion. Monitor: urine output, lactate. If hypovolaemic from blood loss: TRANSFUSE (blood, not crystalloid — avoids volume overload). 'Dry' strategy preferred in isolated pulmonary contusion.^[25]
Surgical rib fixation — selected patients. Flail chest or severely displaced fractures → surgical fixation (plates/screws to stabilise rib cage). Benefits: reduced pain, faster recovery, earlier extubation, fewer complications (pneumonia). EVIDENCE: meta-analyses of randomised trials show benefit (reduced ICU stay, ventilation days, pneumonia). INDICATIONS: (a) Flail chest with respiratory failure. (b) Severely displaced fractures (chest wall deformity). (c) Refractory pain (non-operative management failed). (d) Thoracotomy for other reason (fix ribs while in chest). NOT for: all rib fractures (most heal without surgery).^[4]
Traumatic aortic injury — most victims die at the scene. Survivors have a partial transection (contained by adventitia/mediastinal tissue). PRESENTATION: (a) Widened mediastinum on CXR. (b) Apical cap (blood pleural, left apex). (c) Depressed left main bronchus. (d) NG tube deviation. (e) Loss of aortic knob. (f) BP differential (upper extremity SBP > lower — partial obstruction). CT ANGIOGRAPHY: definitive. MANAGEMENT: (a) Heart-rate and BP control ('impulse control' — beta-blocker first; esmolol-based regimens are standard in contemporary grade I–II management). (b) TEVAR (thoracic endovascular aortic repair) — preferred (SVS systematic review: mortality 9% endovascular vs 19% open vs 46% nonoperative). (c) Open repair (if TEVAR not suitable).^[5]^[29]
Tension pneumothorax — IMMEDIATE decompression (don't wait for CXR). CLINICAL: hypotension, hypoxia, tachycardia, tracheal deviation (late), absent breath sounds (affected side), distended neck veins (from increased intrathoracic pressure). MANAGEMENT: (a) NEEDLE DECOMPRESSION immediately at a standard decompression site (2nd intercostal space midclavicular line or 5th ICS mid-axillary line per local protocol). (b) Release of air = rush of air = diagnosis confirmed. (c) Then: formal large-bore CHEST DRAIN (tube thoracostomy). DON'T WAIT for CXR (patient may die).^[1]
Haemothorax — chest drain, monitor output. CHEST DRAIN: large bore (blood is viscous — small drains block). THORACOTOMY indications (emergency): criteria for surgical intervention in initial haemothorax are well defined in the literature — massive initial drainage, ongoing active bleeding, persistent blood transfusion requirement. (d) Clotted haemothorax (drain can't evacuate — needs surgery to evacuate clot).^[14]
Epidural analgesia — BEST for rib fracture pain. Epidural (thoracic — T5-T8 level): local anaesthetic (bupivacaine/ropivacaine) + opioid (fentanyl). Benefits: (1) Superior analgesia (allows deep breathing, coughing, clearance of secretions). (2) Reduced pneumonia (better chest expansion). (3) Reduced need for systemic opioids (less sedation, delirium). (4) May reduce need for intubation (if pain-controlled, can breathe adequately). CAUTIONS: coagulopathy (trauma — check platelets/INR before inserting), hypotension (sympathetic block — vasopressors may be needed), neurological assessment (epidural may mask spinal injury). Paravertebral block: alternative (less hypotension, unilateral). A Bayesian network meta-analysis of randomised trials compares thoracic epidural, ESP, serratus anterior, paravertebral, intercostal and intrapleural techniques against intravenous analgesia.^[22]
Sternal fracture — assess for cardiac injury. Sternal fracture (from direct impact — steering wheel, seatbelt): BCI documented in 9.5% in a nationwide cohort (associated with greater injury severity and critical care use, though not higher mortality); EAST notes a sternal fracture ALONE does not predict BCI — screen ALL significant blunt chest trauma with ECG + troponin I. ASSESS: ECG, troponin I; echo only if hypotension/arrhythmia. MOST sternal fractures: stable (no displacement) — managed conservatively (analgesia). Unstable (displaced): surgical fixation. MECHANISM: direct compression of heart between sternum and spine → myocardial contusion.^[10]^[3]
Diaphragmatic injury — often missed. Blunt (rare) or penetrating. Left diaphragm more common (liver protects right). PRESENTATION: delayed (herniation of abdominal contents into chest — bowel sounds in chest, respiratory compromise). DIAGNOSIS: CT (often missed on CXR — nasogastric tube curled in chest). MANAGEMENT: surgical repair (laparotomy/thoracotomy). IMPORTANT: consider in ALL penetrating thoracoabdominal trauma (lower chest/upper abdomen — diaphragm traversed).^[1]
Tracheobronchial injury — rare but life-threatening. MECHANISM: direct crush or deceleration (bronchus tears at carina — most common site). PRESENTATION: massive air leak (continuous bubbling in chest drain — doesn't resolve), pneumothorax that doesn't re-expand with drain, subcutaneous emphysema (extensive). DIAGNOSIS: bronchoscopy (visualise tear). MANAGEMENT: surgical repair (thoracic surgery). May need: double-lumen tube (isolate injured lung).^[1]
Multiple rib fractures = significant injury. Even without flail chest: multiple rib fractures → significant pain, respiratory compromise, pneumonia risk. ICU/HDU admission for: (a) Age >65. (b) Multiple (≥3) rib fractures. (c) Pre-existing lung disease (COPD). (d) Hypoxaemia despite oxygen. (e) Inability to cough/breathe deeply (poor analgesia). AGGRESSIVE management: analgesia (epidural), pulmonary physiotherapy, HFNC/NIV if hypoxic, monitor closely.^[30]
Chest trauma + concurrent injuries. Multi-system injury is the RULE: in a nationwide sternal-fracture cohort, rib fractures co-existed in 51%, spinal fractures in 36%, and lung contusions in 18%; 35% were severely injured (ISS ≥ 16). FULL TRAUMA SURVEY (primary + secondary): don't focus on chest alone — miss abdominal bleeding, spinal injury, TBI. PRIORITISE: life-threatening injuries first (ABC — airway, breathing, circulation). CHEST TRAUMA is often the cause of early death (tension pneumo, aortic injury, massive haemothorax).^[10]

References31Show

[1]Griffard J, et al. Management of blunt chest trauma. Surgical clinics of North America, 2024.PMID 38453306
[2]Walkey AJ, et al. Use of airway pressure release ventilation is associated with a reduced incidence of ventilator-associated pneumonia in patients with pulmonary contusion. Journal of trauma, 2011.PMID 20526208
[3]Clancy K, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of trauma and acute care surgery, 2012.PMID 23114485
[4]Sharma VJ, et al. Surgical stabilisation of rib fractures: a meta-analysis of randomised controlled trials. Injury, 2024.PMID 38945079
[5]Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. Journal of vascular surgery, 2011.PMID 20974523
[6]El-Qawaqzeh K, et al. Predictors of mortality in blunt cardiac injury: a nationwide analysis. Journal of surgical research, 2023.PMID 36108535
[7]Maron BJ, et al. Clinical profile and spectrum of commotio cordis. JAMA, 2002.PMID 11879111
[8]Sohail S, et al. Commotio cordis in non-sports-related injury: a scoping review. Current problems in cardiology, 2024.PMID 37890546
[9]Salzillo C, et al. Commotio cordis in sudden cardiac death in the young: a state-of-the-art review. Reviews in cardiovascular medicine, 2025.PMID 41089808
[10]Klei DS, et al. Epidemiology and outcomes of traumatic sternal fractures and associated blunt cardiac injury. European journal of trauma and emergency surgery, 2026.PMID 42223595
[11]Fokin AA, et al. Blunt cardiac injury in patients with sternal fractures. Cureus, 2022.PMID 35382179
[12]Grigorian A, et al. National risk factors for blunt cardiac injury: hemopneumothorax is the strongest predictor. American journal of surgery, 2019.PMID 30060913
[13]Chou YP, et al. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Current opinion in pulmonary medicine, 2015.PMID 25978625
[14]Broderick SR, et al. Hemothorax: etiology, diagnosis, and management. Thoracic surgery clinics, 2013.PMID 23206720
[15]Shemmeri E, et al. Blunt tracheobronchial trauma. Thoracic surgery clinics, 2018.PMID 30054080
[16]Grewal HS, et al. Treatment of tracheobronchial injuries: a contemporary review. Chest, 2019.PMID 30059680
[17]Fabien JJ, et al. Blunt traumatic esophageal injury: decreased mortality with urgent repair. American surgeon, 2022.PMID 35466715
[18]Bryant AS, et al. Esophageal trauma. Thoracic surgery clinics, 2007.PMID 17650698
[19]Hisamune R, Kobayashi M, Nakasato K, et al. A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures. World journal of emergency surgery : WJES, 2024.PMID 38504282
[20]Beks RB, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed — a systematic review. European journal of trauma and emergency surgery, 2019.PMID 30276722
[21]Wallen TE, et al. Intercostal liposomal bupivacaine injection for rib fractures: a prospective randomised controlled trial. Journal of trauma and acute care surgery, 2022.PMID 34789700
[22]Gamberini L, et al. Regional anaesthesia modalities in blunt thoracic trauma: a systematic review and Bayesian network meta-analysis. American journal of emergency medicine, 2025.PMID 39740311
[23]Rhee PM, et al. Survival after emergency department thoracotomy: review of published data from the past 25 years. Journal of the American College of Surgeons, 2000.PMID 10703853
[24]Joseph B, et al. Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program. Trauma surgery and acute care open, 2018.PMID 30402559
[25]Cohn SM, DuBose JJ. Pulmonary contusion: an update on recent advances in clinical management. World journal of surgery, 2010.PMID 20407767
[26]Maron BJ, Haas TS, Ahluwalia A, et al. Increasing survival rate from commotio cordis. Heart rhythm, 2013.PMID 23107651
[27]Edu S, Nicol A, Neuhaus V, et al. Late video-assisted thoracoscopic surgery versus thoracostomy tube reinsertion for retained hemothorax after penetrating trauma: a prospective randomized control study. World journal of surgery, 2024.PMID 38588034
[28]Abid A, Ahmad T, Shaikh KA, et al. Video Assisted Thoracoscopy as a therapeutic modality in evacuating retained or clotted haemothoraces. Journal of the Pakistan Medical Association, 2021.PMID 34091628
[29]Tran JN, Byerly S, Gross M, et al. Adherence of Impulse Control in Primary Management of Grade I and II Blunt Thoracic Aortic Injury. Journal of surgical research, 2026.PMID 42190440
[30]Velez DR, Adamska N, Dickinson A, et al. Evolving Outcomes After Rib Fractures in Geriatric Patients: Revisiting Historical Data in the Modern Era. Journal of surgical research, 2026.PMID 41934834
[31]Carver TW, Berndtson AE, McNickle AG, et al. Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: a Western Trauma Association multicenter study. Journal of trauma and acute care surgery, 2024.PMID 38764139

Chest trauma and blunt cardiac injury in ICU

Also known as Chest trauma · Blunt cardiac injury · Cardiac contusion · Flail chest · Pulmonary contusion · Traumatic aortic injury · Thoracic trauma

high31 referencesUpdated 26 July 202633 min readVerification in progress

Practise this topic

8 MCQs

Injury

Mechanism

Key features

Management

Flail chest

≥3 consecutive ribs fractured in ≥2 places

Paradoxical chest wall movement, severe pain, respiratory failure

Analgesia (epidural), ventilation if respiratory failure, surgical fixation (selected)

Pulmonary contusion

Direct impact → alveolar haemorrhage

Hypoxia WORSENS 24-48h, diffuse infiltrates

Oxygen, lung-protective ventilation if severe, avoid fluid overload

Blunt cardiac injury

Direct impact to heart

Troponin elevated, arrhythmia (AF, VT, heart block), rarely pump failure

ECG monitoring 24-48h, troponin, echo, treat arrhythmia

Traumatic aortic injury

Deceleration → aortic transection

Widened mediastinum, haemothorax, BP differential

CT angiography → TEVAR (endovascular) or open repair

Tension pneumothorax

Air under pressure in pleura

Hypotension, tracheal deviation, absent breath sounds

IMMEDIATE needle decompression (2nd ICS MCL), then chest drain

Haemothorax

Bleeding into pleural space

Dullness, decreased breath sounds, hypovolaemia

Chest drain (large bore), thoracotomy for massive initial drainage or ongoing bleeding

Clinical pearls

References31Show

[1]Griffard J, et al. Management of blunt chest trauma. Surgical clinics of North America, 2024.PMID 38453306
[2]Walkey AJ, et al. Use of airway pressure release ventilation is associated with a reduced incidence of ventilator-associated pneumonia in patients with pulmonary contusion. Journal of trauma, 2011.PMID 20526208
[3]Clancy K, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of trauma and acute care surgery, 2012.PMID 23114485
[4]Sharma VJ, et al. Surgical stabilisation of rib fractures: a meta-analysis of randomised controlled trials. Injury, 2024.PMID 38945079
[5]Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. Journal of vascular surgery, 2011.PMID 20974523
[6]El-Qawaqzeh K, et al. Predictors of mortality in blunt cardiac injury: a nationwide analysis. Journal of surgical research, 2023.PMID 36108535
[7]Maron BJ, et al. Clinical profile and spectrum of commotio cordis. JAMA, 2002.PMID 11879111
[8]Sohail S, et al. Commotio cordis in non-sports-related injury: a scoping review. Current problems in cardiology, 2024.PMID 37890546
[9]Salzillo C, et al. Commotio cordis in sudden cardiac death in the young: a state-of-the-art review. Reviews in cardiovascular medicine, 2025.PMID 41089808
[10]Klei DS, et al. Epidemiology and outcomes of traumatic sternal fractures and associated blunt cardiac injury. European journal of trauma and emergency surgery, 2026.PMID 42223595
[11]Fokin AA, et al. Blunt cardiac injury in patients with sternal fractures. Cureus, 2022.PMID 35382179
[12]Grigorian A, et al. National risk factors for blunt cardiac injury: hemopneumothorax is the strongest predictor. American journal of surgery, 2019.PMID 30060913
[13]Chou YP, et al. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Current opinion in pulmonary medicine, 2015.PMID 25978625
[14]Broderick SR, et al. Hemothorax: etiology, diagnosis, and management. Thoracic surgery clinics, 2013.PMID 23206720
[15]Shemmeri E, et al. Blunt tracheobronchial trauma. Thoracic surgery clinics, 2018.PMID 30054080
[16]Grewal HS, et al. Treatment of tracheobronchial injuries: a contemporary review. Chest, 2019.PMID 30059680
[17]Fabien JJ, et al. Blunt traumatic esophageal injury: decreased mortality with urgent repair. American surgeon, 2022.PMID 35466715
[18]Bryant AS, et al. Esophageal trauma. Thoracic surgery clinics, 2007.PMID 17650698
[19]Hisamune R, Kobayashi M, Nakasato K, et al. A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures. World journal of emergency surgery : WJES, 2024.PMID 38504282
[20]Beks RB, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed — a systematic review. European journal of trauma and emergency surgery, 2019.PMID 30276722
[21]Wallen TE, et al. Intercostal liposomal bupivacaine injection for rib fractures: a prospective randomised controlled trial. Journal of trauma and acute care surgery, 2022.PMID 34789700
[22]Gamberini L, et al. Regional anaesthesia modalities in blunt thoracic trauma: a systematic review and Bayesian network meta-analysis. American journal of emergency medicine, 2025.PMID 39740311
[23]Rhee PM, et al. Survival after emergency department thoracotomy: review of published data from the past 25 years. Journal of the American College of Surgeons, 2000.PMID 10703853
[24]Joseph B, et al. Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program. Trauma surgery and acute care open, 2018.PMID 30402559
[25]Cohn SM, DuBose JJ. Pulmonary contusion: an update on recent advances in clinical management. World journal of surgery, 2010.PMID 20407767
[26]Maron BJ, Haas TS, Ahluwalia A, et al. Increasing survival rate from commotio cordis. Heart rhythm, 2013.PMID 23107651
[27]Edu S, Nicol A, Neuhaus V, et al. Late video-assisted thoracoscopic surgery versus thoracostomy tube reinsertion for retained hemothorax after penetrating trauma: a prospective randomized control study. World journal of surgery, 2024.PMID 38588034
[28]Abid A, Ahmad T, Shaikh KA, et al. Video Assisted Thoracoscopy as a therapeutic modality in evacuating retained or clotted haemothoraces. Journal of the Pakistan Medical Association, 2021.PMID 34091628
[29]Tran JN, Byerly S, Gross M, et al. Adherence of Impulse Control in Primary Management of Grade I and II Blunt Thoracic Aortic Injury. Journal of surgical research, 2026.PMID 42190440
[30]Velez DR, Adamska N, Dickinson A, et al. Evolving Outcomes After Rib Fractures in Geriatric Patients: Revisiting Historical Data in the Modern Era. Journal of surgical research, 2026.PMID 41934834
[31]Carver TW, Berndtson AE, McNickle AG, et al. Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: a Western Trauma Association multicenter study. Journal of trauma and acute care surgery, 2024.PMID 38764139