Twenty five per cent of trauma deaths are directly caused by injury to the thorax and, while a minority will require emergency surgery, up to eighty five per cent of chest injuries can be managed without the need for formal surgical intervention.1 In these cases, rapid recognition and management of life-threatening conditions are key to successful resuscitation.
Thoracostomy (the creation of an artificial opening in the chest wall) is a procedure performed for decompression of the chest, usually by our pre-hospital, surgical or emergency medicine colleagues. It is also the first stage to placing a tube thoracostomy or ‘open’ chest drain. In the context of trauma, emergency lateral thoracostomy is indicated in the following circumstances:
- traumatic tension pneumothorax
- massive haemothorax
- traumatic cardiac arrest.