Key Points

• Most thoracic trauma patients are managed with a thorough diagnostic evaluation and conservative treatment. Eighty-five percent of thoracic injury can be managed without an operation.
• Patients with major thoracic vascular, cardiac, or airway injury require operative intervention as soon as possible.
• Trauma resuscitation corrects shock-related acidosis and coagulopathy and avoids hypothermia and hypertension.
• An admission chest X-ray and bedside ultrasonography are excellent screening tools. Multidetector Computed Tomography, with intravenous contrast, provides accurate imaging of thoracic vasculature, organs and bones. Endoscopy is superior for the diagnosis of hollow viscus injury.
• Surgical intervention in the emergency department, chest tube placement, and thoracotomy can be lifesaving.