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■ CT with contrast is a good test for stable patients.

■ Transesophageal echocardiogram can be performed at the bedside in

unstable patients.

TREATMENT

■ Useβ-blockade to control blood pressure (keep SBP < 120 mmHg and

replace fluids carefully, to prevent worsening tear/rupture).

■ Instruct patient not to valsalva.

■ Operative repairis almost always necessary, but there is no clear consen-

sus as to the optimal timing (immediate or delayed) or method (open vs

intravascular).

PENETRATING CHEST TRAUMA

Open Pneumothorax (Sucking Chest Wound)

MECHANISMS

■ Open communication between outer chest wall and pleural space with air

moving in and out

■ Usually resulting from a large chest stab wound or GSW

SYMPTOMS/EXAM

■ Shortness of breath

■ Decreased breath sounds

TRAUMA

A B

FIGURE 3.12. Traumatic aortic disruption. Anterior-posterior view showing wide mediastinum (A). Lateral view with

contrast showing defect in the anterior aspect of the descending aorta (B).

(Reproduced, with permission, from Fuster V, Alexander RW, O’Rourke RA. Hurst’s The Heart, 12th ed. New York: McGraw-Hill,

2008:2207.)

Ninety percent of blunt aortic

injuries occur at the isthmus of

the aorta, between left

subclavian artery and

ligamentum arteriosum. The

second most common great

vessel injury is to the

innominate artery.

Symptoms of descending

aortic injury include

paraplegia (vertebral artery

deficits), mesenteric and LE

ischemia, and anuria.