Experiences in the management of chest injuries and a review of current management.

Eleven cases of chest trauma managed in the Intensive Care Unit (ICU), Alexandra Hospital were reviewed. Common manifestations were: rib fractures, haemothorax, pneumothorax, pulmonary contusion and flail chest. Nine patients had fractures on other sites of the body and three patients had associated abdominal injuries requiring laparotomy. Patients were referred to the ICU only when they were in respiratory distress. Transfer to the ICU occurred one to three days after admission to the hospital. Eight patients subsequently had to be ventilated. Two patients died. Respiratory failure in chest trauma is often the result of damage to the parenchyma, atelectasis and infection. Whilst the extent of parenchyma lung damage is dependent upon the severity of the injury and therefore not medically preventable, atelectasis and infection can be avoided. Patients with significant chest trauma should therefore be admitted directly to the Intensive Care Unit and the 'Expectant Therapy' instituted.