Penetrating Chest Wounds

Depending on its size, a penetrating chest wound may cause varying degrees of damage to bones, soft tissue, blood vessels, and nerves.

The risk of death and disease from a chest wound depends on the size and severity of the wound. Gunshot wounds are usually more serious than stab wounds because they cause more severe lacerations and rapid blood loss and because ricochet commonly damages large areas and multiple organs. With prompt, aggressive treatment, up to 90% of patients with penetrating chest wounds recover.

Causes

Stab wounds from a knife or an ice pick and gunshot wounds are the most common penetrating chest wounds. Explosions or firearms fired at close range are the usual source of large, gaping wounds.

Diagnostic tests

Chest X-rays allow evaluation of the injury and confirm chest tube placement. Additional tests may include arteriography, aortography, bronchoscopy, computed tomography scanning, echocardiography, and esophagoscopy.

Treatment

In a penetrating chest wound, treatment involves maintaining a patent airway and providing ventilatory support as needed. Chest tube insertion allows the reestablishment of intrathoracic pressure and drainage of blood from a hemothorax.

The patient's wound needs surgical repair. The patient also may need analgesics, antibiotics, tetanus prophylaxis, and infusion of blood products and I.V. fluids.

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