Swan-Ganz catheterization may be appropriate with assessment of the mixed venous oxygen saturation. Management of Specific Injuries A. Thorax. Penetrating injuries must be evaluated for hemothorax and pneumothorax, and cardiac, great vessel and esophageal injuries. Blunt injuries stem from direct blow, deceleration, or compression forces. Rib fracture is the most common injury, and scapular, sternal and first rib fractures suggest massive force.
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.