RT Book, Section A1 Coleman, Jamie J. A1 Pieracci, Fredric M. A1 DuBose, Joseph J. A1 Scalea, Thomas M. A1 O’Connor, James V. A2 Feliciano, David V. A2 Mattox, Kenneth L. A2 Moore, Ernest E. SR Print(0) ID 1175133692 T1 Chest Wall and Lung T2 Trauma, 9e YR 2020 FD 2020 PB McGraw Hill PP New York, NY SN 9781260143348 LK accesssurgery.mhmedical.com/content.aspx?aid=1175133692 RD 2024/03/28 AB KEY POINTSOnly 7% (blunt trauma) to 15% (penetrating trauma) of patients with thoracic trauma will require a thoracotomy.The ribs are flexible, the sharpest angle of the rib occurs posteriorly at the tubercle, and the ribs are furthest apart from one another anteriorly.Currently available classification systems for rib fractures include the Organ Injury Scale–Chest, Rib Fracture Score, Chest Trauma Score, and RibScore.Both acetaminophen and nonsteroidal anti-inflammatory drugs have been shown to provide comparable analgesia to oral narcotics in trauma patients and should be given routinely to patients with injury to the chest wall.Surgical stabilization of rib fractures is currently recommended for patients with a flail segment and a poor response to nonoperative therapy or associated respiratory failure, patients with multiple displaced rib fractures, and patients with multiple nondisplaced fractures that undergo interval displacement and worsening clinical status.Prolonged (ie, 7–10 days) trials of nonoperative management in patients with multiple displaced rib fractures increase the risk of pulmonary compromise.A large pneumothorax seen on computed tomography, but not detected on a chest x-ray, is most often anterior.Indications for a thoracotomy for a hemothorax include initial chest tube drainage (15–30 minutes) of 1200 to 1500 mL or 200 mL/h for 2 to 4 hours.Significant injuries to the lung, particularly those from gunshot wounds and away from the hilum, are often best treated with pulmonotomy and selective vascular ligation.A “persistent” air leak after 5 to 7 days of drainage of the pleural cavity can be treated with autologous blood pleurodesis, a commercially available sealant, an endobronchial one-way valve, a Heimlich valve, or a thoracotomy.