Penetrating chest trauma (mechanism of disease)

ERRATA:
Significant omission: Vascular injury (such as to the aorta or vena cava) can also cause hypovolemic (hemorrhagic) shock.
This is a flowchart on penetrating chest trauma, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Diaphragmatic hernia
Risk factors / SDOH
Cell / tissue damage
Structural factors
Medicine / iatrogenic
Infectious / microbial
Pressure physiology
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental / exposure
Cancer / neoplasm
Cardiorespiratory pathology
Pathophysiology
Etiology
Manifestations
Thrusting action of a pointed object (e.g., knife, broken bottle)
Tissue is lacerated and torn along the path of the object
Stab wounds:
Depth of injury usually greater than the width
Tissue is lacerated and crushed along the path of the bullet
Gun shot wounds:
Tissue displaced forward and radially → cavitation and pressure injury of nearby structures.
Dense organs (liver, bone) absorb more kinetic energy than less dense organs, resulting in greater injury
Severity of injury is related to the kinetic energy of the bullet (i.e., weight, velocity)
Penetrating chest trauma: open wound injury with deep but relatively narrow entry wound
Cardiac tamponade: ↑ intrapericardial pressure from pericardial effusion → compression of heart
Hemothorax: blood
in the pleural cavity
Pneumothorax: pleural cavity air → lung collapse
Tracheobronchial injury
Diaphragmatic injury
Spinal cord injury
Fractures (rib, vertebral)
Hypotension
Muffled heart sounds
↑ JVP → Distended neck veins
Tachycardia, pulsus paradoxus
Pallor, cold sweats
Left heart failure
Right heart failure
Peripheral edema
Hepatojugular reflux
Hepatosplenomegaly
Jugular venous distension
Obstructive shock
Hemorrhagic shock
Respiratory distress, hypoxia
Chest pain
↓ or absent breath sounds
↓ tactile fremitus
Dullness on percussion
Flat neck veins
Distended neck veins, tracheal deviation
Tension pneumo.
Obstructive shock
Beck’s triad
Dyspnea
Sternal tenderness
Subcutaneous emphysema
Hoarseness, dysphonia
Bloody tracheal secretions
CXR: air in surrounding soft tissue
Bowel obstruction
Dyspnea; ↓ breath sounds; bowel sounds in chest
Obstipation: complete inability to pass stool or gas
Sensory and/or motor disturbances below the level of injury
Local pain on pressure, percussion, compression, inspiration
=3 ribs in =2 places → Flail chest with paradoxical movement
Acute dyspnea, orthopnea (worse when supine)
Hypotension, tachycardia
Coughing or wheezing, coarse crackles/rales
Weak, fatigue, AMS, cold, clammy, cyanosis
Penetrating chest trauma
Progressively ↑ pressure within chest