Thoracic injuries result in hypoxemia, hypovolemia, or myocardial failure. Hypoxia stems from airway obstruction, pneumothorax, flail chest, pulmonary contusion, tracheobronchial injury, or diaphragm rupture. Myocardial failure is from cardiac contusion, tamponade, rupture of septum or valves or air embolism. Four or more ribs injured in two locations may result in a sufficient degree of paradoxical respiration that hypoventilation occurs. This may not manifest until after a several hour delay.
Pulmonary contusion is a major component of the injury complex.
Great care must be taken to avoid fluid overload and worsen the gas exchange. Open Pneumothorax, i.e. sucking chest wound, requires a pulmonary parenchymal injury with an air leak and a chest wall defect that allows free air transfer in and out of the thorax. A one way valve would result in a tension pneumothorax. Plan closure of the chest wall and chest tube. 1000 ml's of blood.