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Blunt trauma

Last updated: September 20, 2021

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Blunt trauma is most commonly due to motor vehicle accidents and is a major cause of morbidity and mortality in all age groups. The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. The patterns of chest injury are highly dependent on the intensity of the trauma and may vary from harmless contusions to possible life-threatening injuries of the heart and/or the aorta. Management is initially focused on the ABCs (airway, breathing, circulation). FAST and CT imaging are used to detect intraabdominal bleeding and organ damage, while chest x-ray is the most important initial diagnostic tool in the assessment of blunt chest trauma. Treatment depends on the specific injury, as well as the hemodynamic status of the patient. Conservative management with close monitoring is indicated for hemodynamically stable patients. However, emergency surgery is often necessary. This article provides a brief overview of the clinical features and management of blunt trauma to the abdomen and chest.

For information on prehospital care and general principles of trauma management, see “Prehospital trauma care.”
Penetrating trauma is discussed in its own article.

  • Etiology
    • Motor vehicle accidents (50–75%)
    • Falls
  • Mechanism of injury
    • Rapid deceleration: results in shear forces that cause vascular tears, as well as hollow and solid organ contusions and ruptures
    • External compression and crushing

Possible injuries

Clinical features

Approach to blunt abdominal trauma

The absence of pain does not rule out significant intra-abdominal injury. Imaging must be performed.

If FAST exam is not available, a hemodynamically unstable patient should be taken to the operating room immediately.

Possible injuries

Clinical features

Approach to blunt chest trauma

Rib fracture

Phrenic nerve paralysis

Cardiac injury

Aortic injury and traumatic rupture of the aorta (aortic rupture)

Pulmonary contusion

Tracheobronchial injury (TBI)

Pneumomediastinum [1]

Diaphragmatic rupture

See “Diaphragmatic rupture.”

  1. Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis. 2015; 7 (Suppl 1): p.S44-49. doi: 10.3978/j.issn.2072-1439.2015.01.11 . | Open in Read by QxMD