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What are the consequences of thoracic trauma?
Of the 92,000 annual deaths caused by unintentional injuries, 41,000 result from motor-vehicle-related trauma, which carries a high risk of chest injury. Similarly, of the 52,000 deaths caused by intentional injuries, 21,000 are also highly likely to have injuries to the chest. It is estimated that 12–21% of all trauma deaths result primarily from blunt and penetrating chest injury. It has also been estimated that for each chest-trauma-related death, there are 100 nonfatal tho-racic injuries. Not all intrathoracic organs are at equal risk of injury. The chest wall (50–71%) and lungs (21–26%) are the most commonly involved structures. The heart (7–9%), aorta and great vessels (4%), esophagus (7%) and diaphragm (0.5–7%) are less likely to be involved.
While cardiothoracic trauma is a major contributor to trauma mortality, in 80% of cases it coexists with other injuries which commonly require major surgery.
Some serious thoracic organ injuries may be clinically silent, thus active clinical suspicion and sophisticated diagnostic measures may be required to detect them. Physiologic derangements from chest injuries are multidimensional; some clinicians use the term “thoracic shock” to describe them. Pulmonary failure, hemorrhage, and cardiac failure, each of which may be caused by various injuries, are the main components of thoracic shock. Individually or in combina-tion, each of these can interfere with oxygen delivery, consumption, and extraction, and potentially shift oxygen utilization from flow-independent to a flow-dependent state, with associated anaerobic tissue metabolism and lactic acidosis.
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