medium-chain triglycerides, which is absorbed directly into the portal system,
rather than the lymphatics. While on a diet, the chest tube output should be
monitored closely. If drainage persists or increases, the patient should be
made nothing by mouth and total parental nutrition should be initiated.
Octreotide is a long-acting somatostatin analog, which acts directly on vascular
somatostatin receptors, may also be considered for adjunctive therapy to
decrease lymph fluid excretion. Traumatic chylothorax typically resolves with
non-operative management within 10 to 14 days. However, when conservative
measures fail, operative ligation of the thoracic duct through thoracotomy or
video-assisted thoracic surgery may be necessary.
L. Penetrating Lung Injuries
Penetrating wounds occur almost exclusively in teenagers in the
pediatric population and account for 10% to 15% of pediatric trauma cases.
Injuries are usually the result of stab wounds or gunshots. In comparison to
blunt chest trauma, penetrating chest injuries are associated with higher rates
of operative intervention and mortality.
Stab wounds to the chest should be evaluated for penetration into the
thoracic cavity. Suggestive physical exam findings include crepitus in the
subcutaneous tissue or active air movement through the wound itself. Open
“sucking” chest wounds require immediate attention. Placement of a three-
sided occlusive dressing over the wound can be a life-saving maneuver and
prevents the precipitation of a tension pneumothorax.