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Copyright (c) 2025 Alqahtani Saleh Ayed, Abdullah Saeed Misfer Al Dawsri, Mubark Ali Mubark Alshrudh, Mansour Abdu Abdullah Rajhi, Tariq Ahmed Sabih Alatawi, Ali Abdallah Ali Aldosari, Mohammed Abdu Abdullah Rajhi, ANAS IBRAHIM ALGHANNAM, Abdullah Ahmed Aqeel Sayram, Bassam Ali Tumayhi, Mohammad Qassim Ahmad Hijri, Turki Magbool Salem Alazmi, Khalid Ali Obidan Alarashidi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Comprehensive Multidisciplinary Management of Postoperative Thoracic Surgery Patients: Imaging Assessment, Intraoperative Support, Respiratory Care, and Early Rehabilitation
Corresponding Author(s) : Alqahtani Saleh Ayed
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Chest trauma remains a leading cause of morbidity and mortality worldwide, particularly in polytrauma patients. The thorax contains vital organs, and injury can rapidly compromise respiratory and cardiovascular function, making prompt diagnosis and coordinated management essential.
Aim: This article aims to provide a comprehensive overview of chest trauma, focusing on anatomy, etiology, pathophysiology, clinical evaluation, imaging modalities, and evidence-based management strategies to improve patient outcomes.
Methods: A narrative, multidisciplinary review was conducted, integrating current principles of trauma care, Advanced Trauma Life Support (ATLS) protocols, radiologic assessment, and surgical and non-surgical management approaches for blunt and penetrating thoracic injuries.
Results: Chest trauma most commonly results from blunt mechanisms such as motor vehicle collisions and falls, with pneumothorax, hemothorax, pulmonary contusion, and cardiac injury being frequent complications. Early use of chest radiography, eFAST, and computed tomography enhances diagnostic accuracy. Most injuries can be managed nonoperatively with careful monitoring, pain control, respiratory support, and timely intervention when indicated. Surgical management is reserved for specific life‑threatening conditions or refractory cases.
Conclusion: Effective chest trauma management requires rapid assessment, accurate imaging, vigilant monitoring, and a multidisciplinary approach. Early recognition and timely intervention significantly reduce preventable morbidity and mortality.
Keywords
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- 1. Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017 Apr 20;25(1):42.
- 2. Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304.
- 3. Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. 2007 Feb;17(1):1-9.
- 4. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994 Dec;37(6):975-9.
- 5. Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009 Oct;33(5):1425-33.
- 6. Sweet AAR, de Bruin IGJ, Peek J, IJpma FFA, van Baal MCPM, Leenen LPH, Houwert RM. Epidemiology and outcomes of traumatic chest injuries in children: a nationwide study in the Netherlands. Eur J Pediatr. 2023 Apr;182(4):1887-1896.
- 7. Helsloot D, Fitzgerald MC, Lefering R, Verelst S, Missant C., TraumaRegister DGU® The first hour of trauma reception is critical for patients with major thoracic trauma: A retrospective analysis from the TraumaRegister DGU. Eur J Anaesthesiol. 2023 Nov 01;40(11):865-873.
- 8. Polmear MM, Kakalecik J, Croft C, Hagen JE. Early Care of Polytraumatized Patients: A Framework for Orthopaedic Surgeons. J Am Acad Orthop Surg. 2024 Dec 31;
- 9. Ekpe EE, Eyo C. Determinants of mortality in chest trauma patients. Niger J Surg. 2014 Jan;20(1):30-4.
- 10. Demetriades D, Kimbrell B, Salim A, Velmahos G, Rhee P, Preston C, Gruzinski G, Chan L. Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept? J Am Coll Surg. 2005 Sep;201(3):343-8.
- 11. Inocencio M, Childs J, Chilstrom ML, Berona K. Ultrasound Findings in Tension Pneumothorax: A Case Report. J Emerg Med. 2017 Jun;52(6):e217-e220.
- 12. Ebrahimi A, Yousefifard M, Mohammad Kazemi H, Rasouli HR, Asady H, Moghadas Jafari A, Hosseini M. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos. 2014;13(4):29-40.
- 13. Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg. 2011 Apr;77(4):480-4.
- 14. Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013 Sep 23;17(5):R208.
- 15. Rodriguez RM, Hendey GW, Mower W, Kea B, Fortman J, Merchant G, Hoffman JR. Derivation of a decision instrument for selective chest radiography in blunt trauma. J Trauma. 2011 Sep;71(3):549-53.
- 16. Rodriguez RM, Anglin D, Langdorf MI, Baumann BM, Hendey GW, Bradley RN, Medak AJ, Raja AS, Juhn P, Fortman J, Mulkerin W, Mower WR. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013 Oct;148(10):940-6.
- 17. Rodriguez RM, Hendey GW, Mower WR. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm). Am J Emerg Med. 2017 Jan;35(1):164-170.
- 18. Dillon DG, Rodriguez RM. Screening performance of the chest X-ray in adult blunt trauma evaluation: Is it effective and what does it miss? Am J Emerg Med. 2021 Nov;49:310-314.
- 19. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005 Sep;12(9):844-9.
- 20. Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock. 2012 Jan;5(1):76-81.
- 21. Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995 Nov;108(5):1345-8.
- 22. Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011 Oct;140(4):859-866.
- 23. Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, Albaladejo P, Ferretti GR, Bosson JL, Payen JF. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012 May;141(5):1177-1183.
- 24. Mumtaz U, Zahur Z, Raza MA, Mumtaz M. Ultrasound And Supine Chest Radiograph In Road Traffic Accident Patients: A Reliable And Convenient Way To Diagnose Pleural Effusion. J Ayub Med Coll Abbottabad. 2017 Oct-Dec;29(4):587-590.
- 25. Schwerin DL, Svancarek B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. EMS Diabetic Protocols For Treat and Release.
- 26. Muse ED, Topol EJ. More than meets the eye: Using AI to identify reduced heart function by electrocardiograms. Med. 2021 Jul 09;2(7):791-793.
- 27. Mowery NT, Gunter OL, Collier BR, Diaz JJ, Haut E, Hildreth A, Holevar M, Mayberry J, Streib E. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011 Feb;70(2):510-8.
- 28. Casós SR, Richardson JD. Role of thoracoscopy in acute management of chest injury. Curr Opin Crit Care. 2006 Dec;12(6):584-9.
- 29. Boutros J, Marquette CH, Ichai C, Leroy S, Benzaquen J. Multidisciplinary management of tracheobronchial injury. Eur Respir Rev. 2022 Mar 31;31(163)
- 30. Chou YP, Lin HL, Wu TC. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Curr Opin Pulm Med. 2015 Jul;21(4):393-8.
- 31. Kirkpatrick AW, Rizoli S, Ouellet JF, Roberts DJ, Sirois M, Ball CG, Xiao ZJ, Tiruta C, Meade M, Trottier V, Zhu G, Chagnon F, Tien H., Canadian Trauma Trials Collaborative and the Research Committee of the Trauma Association of Canada. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. J Trauma Acute Care Surg. 2013 Mar;74(3):747-54; discussion 754-5.
- 32. Lodhia JV, Eyre L, Smith M, Toth L, Troxler M, Milton RS. Management of thoracic trauma. Anaesthesia. 2023 Feb;78(2):225-235.
- 33. Galvagno SM, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox AD, Alley DE, Ditillo M, Joseph BA, Robinson BR, Haut ER. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016 Nov;81(5):936-951.
- 34. Heydari MB, Hessami MA, Setayeshi K, Sajadifar F. Use of prophylactic antibiotics following tube thoracostomy for blunt chest trauma in the prevention of empyema and pneumonia. J Inj Violence Res. 2014 Jul;6(2):91-2.
- 35. Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, Bosarge PL, Love J, Haut ER, Como JJ. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Mar;82(3):618-626.
- 36. Rendeki S, Molnár TF. Pulmonary contusion. J Thorac Dis. 2019 Feb;11(Suppl 2):S141-S151.
- 37. Ganie FA, Lone H, Lone GN, Wani ML, Singh S, Dar AM, Wani NU, Wani SN, Nazeer NU. Lung Contusion: A Clinico-Pathological Entity with Unpredictable Clinical Course. Bull Emerg Trauma. 2013 Jan;1(1):7-16.
- 38. Požgain Z, Kristek D, Lovrić I, Kondža G, Jelavić M, Kocur J, Danilović M. Pulmonary contusions after blunt chest trauma: clinical significance and evaluation of patient management. Eur J Trauma Emerg Surg. 2018 Oct;44(5):773-777.
- 39. Paolone S. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature. Clin Nurs Res. 2017 Dec;26(6):747-762.
- 40. Haller PM, Beer BN, Tonkin AM, Blankenberg S, Neumann JT. Role of Cardiac Biomarkers in Epidemiology and Risk Outcomes. Clin Chem. 2021 Jan 08;67(1):96-106.
- 41. Gao JM, Du DY, Kong LW, Yang J, Li H, Wei GB, Li CH, Liu CP. Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases. World J Surg. 2020 May;44(5):1666-1672.
- 42. Gupta B, Singh Y, Bagaria D, Nagarajappa A. Comprehensive Management of the Patient With Traumatic Cardiac Injury. Anesth Analg. 2023 May 01;136(5):877-893.
- 43. Mouawad NJ, Paulisin J, Hofmeister S, Thomas MB. Blunt thoracic aortic injury - concepts and management. J Cardiothorac Surg. 2020 Apr 19;15(1):62.
- 44. Abila AW, Nditika ME, Kipkemoi RD, Ondigo S, Khwa-Otsyula BO. Primary repair of esophageal perforation: Case report. Int J Surg Case Rep. 2020;71:159-162.
- 45. Rieth A, Varga E, Kovács T, Ottlakán A, Németh T, Furák J. Contemporary management strategies of blunt tracheobronchial injuries. Injury. 2021 Mar;52 Suppl 1:S7-S14.
- 46. Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019 Mar;155(3):595-604.
- 47. Byard RW, Wick R, Simpson E, Gilbert JD. The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults--a 25-year study. Forensic Sci Int. 2006 Jun 02;159(2-3):200-5.
- 48. Colville-Ebeling B, Freeman M, Banner J, Lynnerup N. Autopsy practice in forensic pathology - evidence-based or experience-based? a review of autopsies performed on victims of traumatic asphyxia in a mass disaster. J Forensic Leg Med. 2014 Feb;22:33-6.
- 49. Culhane JT, Mangold MA, Freeman C. Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index. Cureus. 2021 Feb 05;13(2):e13153.
- 50. Deng H, Tang TX, Yao Y, Zhang C, Wu H, Li ZW, Tang LS, Chen D, Chang TD, Yang JZ, Luo JL, Dong L, Yang XP, Tang ZH. The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury. Injury. 2022 Mar;53(3):1073-1080.
- 51. Beshay M, Mertzlufft F, Kottkamp HW, Reymond M, Schmid RA, Branscheid D, Vordemvenne T. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg. 2020 Jul 31;15(1):45.
- 52. Vollrath JT, Schindler CR, Marzi I, Lefering R, Störmann P., TraumaRegister DGU. Lung failure after polytrauma with concomitant thoracic trauma in the elderly: an analysis from the TraumaRegister DGU®. World J Emerg Surg. 2022 Feb 23;17(1):12.
- 53. Kleinpell R, Grabenkort WR, Boyle WA, Vines DL, Olsen KM. The Society of Critical Care Medicine at 50 Years: Interprofessional Practice in Critical Care: Looking Back and Forging Ahead. Crit Care Med. 2021 Dec 01;49(12):2017-2032.
References
1. Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017 Apr 20;25(1):42.
2. Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304.
3. Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. 2007 Feb;17(1):1-9.
4. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994 Dec;37(6):975-9.
5. Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009 Oct;33(5):1425-33.
6. Sweet AAR, de Bruin IGJ, Peek J, IJpma FFA, van Baal MCPM, Leenen LPH, Houwert RM. Epidemiology and outcomes of traumatic chest injuries in children: a nationwide study in the Netherlands. Eur J Pediatr. 2023 Apr;182(4):1887-1896.
7. Helsloot D, Fitzgerald MC, Lefering R, Verelst S, Missant C., TraumaRegister DGU® The first hour of trauma reception is critical for patients with major thoracic trauma: A retrospective analysis from the TraumaRegister DGU. Eur J Anaesthesiol. 2023 Nov 01;40(11):865-873.
8. Polmear MM, Kakalecik J, Croft C, Hagen JE. Early Care of Polytraumatized Patients: A Framework for Orthopaedic Surgeons. J Am Acad Orthop Surg. 2024 Dec 31;
9. Ekpe EE, Eyo C. Determinants of mortality in chest trauma patients. Niger J Surg. 2014 Jan;20(1):30-4.
10. Demetriades D, Kimbrell B, Salim A, Velmahos G, Rhee P, Preston C, Gruzinski G, Chan L. Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept? J Am Coll Surg. 2005 Sep;201(3):343-8.
11. Inocencio M, Childs J, Chilstrom ML, Berona K. Ultrasound Findings in Tension Pneumothorax: A Case Report. J Emerg Med. 2017 Jun;52(6):e217-e220.
12. Ebrahimi A, Yousefifard M, Mohammad Kazemi H, Rasouli HR, Asady H, Moghadas Jafari A, Hosseini M. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos. 2014;13(4):29-40.
13. Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg. 2011 Apr;77(4):480-4.
14. Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013 Sep 23;17(5):R208.
15. Rodriguez RM, Hendey GW, Mower W, Kea B, Fortman J, Merchant G, Hoffman JR. Derivation of a decision instrument for selective chest radiography in blunt trauma. J Trauma. 2011 Sep;71(3):549-53.
16. Rodriguez RM, Anglin D, Langdorf MI, Baumann BM, Hendey GW, Bradley RN, Medak AJ, Raja AS, Juhn P, Fortman J, Mulkerin W, Mower WR. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013 Oct;148(10):940-6.
17. Rodriguez RM, Hendey GW, Mower WR. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm). Am J Emerg Med. 2017 Jan;35(1):164-170.
18. Dillon DG, Rodriguez RM. Screening performance of the chest X-ray in adult blunt trauma evaluation: Is it effective and what does it miss? Am J Emerg Med. 2021 Nov;49:310-314.
19. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005 Sep;12(9):844-9.
20. Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock. 2012 Jan;5(1):76-81.
21. Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995 Nov;108(5):1345-8.
22. Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011 Oct;140(4):859-866.
23. Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, Albaladejo P, Ferretti GR, Bosson JL, Payen JF. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012 May;141(5):1177-1183.
24. Mumtaz U, Zahur Z, Raza MA, Mumtaz M. Ultrasound And Supine Chest Radiograph In Road Traffic Accident Patients: A Reliable And Convenient Way To Diagnose Pleural Effusion. J Ayub Med Coll Abbottabad. 2017 Oct-Dec;29(4):587-590.
25. Schwerin DL, Svancarek B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. EMS Diabetic Protocols For Treat and Release.
26. Muse ED, Topol EJ. More than meets the eye: Using AI to identify reduced heart function by electrocardiograms. Med. 2021 Jul 09;2(7):791-793.
27. Mowery NT, Gunter OL, Collier BR, Diaz JJ, Haut E, Hildreth A, Holevar M, Mayberry J, Streib E. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011 Feb;70(2):510-8.
28. Casós SR, Richardson JD. Role of thoracoscopy in acute management of chest injury. Curr Opin Crit Care. 2006 Dec;12(6):584-9.
29. Boutros J, Marquette CH, Ichai C, Leroy S, Benzaquen J. Multidisciplinary management of tracheobronchial injury. Eur Respir Rev. 2022 Mar 31;31(163)
30. Chou YP, Lin HL, Wu TC. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Curr Opin Pulm Med. 2015 Jul;21(4):393-8.
31. Kirkpatrick AW, Rizoli S, Ouellet JF, Roberts DJ, Sirois M, Ball CG, Xiao ZJ, Tiruta C, Meade M, Trottier V, Zhu G, Chagnon F, Tien H., Canadian Trauma Trials Collaborative and the Research Committee of the Trauma Association of Canada. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. J Trauma Acute Care Surg. 2013 Mar;74(3):747-54; discussion 754-5.
32. Lodhia JV, Eyre L, Smith M, Toth L, Troxler M, Milton RS. Management of thoracic trauma. Anaesthesia. 2023 Feb;78(2):225-235.
33. Galvagno SM, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox AD, Alley DE, Ditillo M, Joseph BA, Robinson BR, Haut ER. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016 Nov;81(5):936-951.
34. Heydari MB, Hessami MA, Setayeshi K, Sajadifar F. Use of prophylactic antibiotics following tube thoracostomy for blunt chest trauma in the prevention of empyema and pneumonia. J Inj Violence Res. 2014 Jul;6(2):91-2.
35. Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, Bosarge PL, Love J, Haut ER, Como JJ. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Mar;82(3):618-626.
36. Rendeki S, Molnár TF. Pulmonary contusion. J Thorac Dis. 2019 Feb;11(Suppl 2):S141-S151.
37. Ganie FA, Lone H, Lone GN, Wani ML, Singh S, Dar AM, Wani NU, Wani SN, Nazeer NU. Lung Contusion: A Clinico-Pathological Entity with Unpredictable Clinical Course. Bull Emerg Trauma. 2013 Jan;1(1):7-16.
38. Požgain Z, Kristek D, Lovrić I, Kondža G, Jelavić M, Kocur J, Danilović M. Pulmonary contusions after blunt chest trauma: clinical significance and evaluation of patient management. Eur J Trauma Emerg Surg. 2018 Oct;44(5):773-777.
39. Paolone S. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature. Clin Nurs Res. 2017 Dec;26(6):747-762.
40. Haller PM, Beer BN, Tonkin AM, Blankenberg S, Neumann JT. Role of Cardiac Biomarkers in Epidemiology and Risk Outcomes. Clin Chem. 2021 Jan 08;67(1):96-106.
41. Gao JM, Du DY, Kong LW, Yang J, Li H, Wei GB, Li CH, Liu CP. Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases. World J Surg. 2020 May;44(5):1666-1672.
42. Gupta B, Singh Y, Bagaria D, Nagarajappa A. Comprehensive Management of the Patient With Traumatic Cardiac Injury. Anesth Analg. 2023 May 01;136(5):877-893.
43. Mouawad NJ, Paulisin J, Hofmeister S, Thomas MB. Blunt thoracic aortic injury - concepts and management. J Cardiothorac Surg. 2020 Apr 19;15(1):62.
44. Abila AW, Nditika ME, Kipkemoi RD, Ondigo S, Khwa-Otsyula BO. Primary repair of esophageal perforation: Case report. Int J Surg Case Rep. 2020;71:159-162.
45. Rieth A, Varga E, Kovács T, Ottlakán A, Németh T, Furák J. Contemporary management strategies of blunt tracheobronchial injuries. Injury. 2021 Mar;52 Suppl 1:S7-S14.
46. Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019 Mar;155(3):595-604.
47. Byard RW, Wick R, Simpson E, Gilbert JD. The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults--a 25-year study. Forensic Sci Int. 2006 Jun 02;159(2-3):200-5.
48. Colville-Ebeling B, Freeman M, Banner J, Lynnerup N. Autopsy practice in forensic pathology - evidence-based or experience-based? a review of autopsies performed on victims of traumatic asphyxia in a mass disaster. J Forensic Leg Med. 2014 Feb;22:33-6.
49. Culhane JT, Mangold MA, Freeman C. Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index. Cureus. 2021 Feb 05;13(2):e13153.
50. Deng H, Tang TX, Yao Y, Zhang C, Wu H, Li ZW, Tang LS, Chen D, Chang TD, Yang JZ, Luo JL, Dong L, Yang XP, Tang ZH. The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury. Injury. 2022 Mar;53(3):1073-1080.
51. Beshay M, Mertzlufft F, Kottkamp HW, Reymond M, Schmid RA, Branscheid D, Vordemvenne T. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg. 2020 Jul 31;15(1):45.
52. Vollrath JT, Schindler CR, Marzi I, Lefering R, Störmann P., TraumaRegister DGU. Lung failure after polytrauma with concomitant thoracic trauma in the elderly: an analysis from the TraumaRegister DGU®. World J Emerg Surg. 2022 Feb 23;17(1):12.
53. Kleinpell R, Grabenkort WR, Boyle WA, Vines DL, Olsen KM. The Society of Critical Care Medicine at 50 Years: Interprofessional Practice in Critical Care: Looking Back and Forging Ahead. Crit Care Med. 2021 Dec 01;49(12):2017-2032.