Pediatric emergency medicine trisk 3725 3725

commonly affected, with the thoracic region having the highest mortality rate
(approximately 35%).
TABLE 115.1
THORACIC TRAUMA INJURIES REQUIRING OPERATIVE
INTERVENTION
Injury

Signs and symptoms

Tracheal/bronchial
Active chest tube air leak, pneumothorax not resolved
rupture
Lung parenchyma,
Chest tube bleeding greater than 2–3 mL/kg/hr or
internal mammary
hypotension unresponsive to transfusions
artery laceration,
intercostal artery
laceration
Esophageal
Abnormal esophagram (uncontained leak) or
disruption
esophagoscopy
Gastric contents in the chest tube
Diaphragmatic
Abnormal gas pattern in the hemithorax
hernia
Displaced nasogastric tube in the hemithorax
Pericardial
Positive pericardiocentesis
tamponade

Great vessel
Widened mediastinum
laceration
Tracheal or nasogastric tube deviation
Blurred aortic knob
Abnormal CT angiogram
The patient’s signs and symptoms will depend on the region injured. Patients
with an esophageal rupture in the cervical region may complain of neck stiffness
or neck pain. They may regurgitate bloody material and have cervical
subcutaneous emphysema or odynophagia. A lateral neck radiograph may show
retroesophageal emphysema. In the thoracic region, patients may present with
abdominal spasms and guarding, chest pain, subcutaneous emphysema,