CHAPTER 115 ■ THORACIC TRAUMA MATTHEW EISENBERG, JOY L COLLINS GOALS OF EMERGENCY THERAPY The initial goals of emergency therapy for the child with thoracic trauma, just as for all forms of major trauma, are assessment and stabilization of airway, breathing, and circulation, all of which are at increased risk due to the location of vital structures within the thorax A thorough primary trauma survey, with immediate steps to correct any deficits in airway, breathing, and circulation before moving on to the next element of assessment, is critical The provider should be prepared to emergently intubate the trachea, provide mechanical ventilation, administer both intravenous fluids (IVFs) and blood products, and perform other emergency interventions such as thoracentesis, thoracostomy, and pericardiocentesis as indicated Respiratory compromise in children with thoracic trauma may be due to obstruction of the airway, injury to the chest wall, lung parenchyma, or central nervous system, or shock Thoracic hemorrhage, obstruction of venous return, or direct injury to the heart may lead to circulatory compromise and shock The evaluation of the child with thoracic trauma is complicated by both physical and developmental differences from adults Detailed further in the sections that follow, these include increased compliance of the thoracic cage, greater susceptibility to air and fluid in the pleural space, a shorter, narrower trachea at greater risk of obstruction, and greater sensitivity to hypoxia Due to fear, pain, separation from caregiver and/or young age, an injured child may not be able to articulate his/her complaints or comply with the examination Therefore, attention to nonverbal cues, vital signs, and careful observation of respiratory and circulatory status are crucial Because approximately 80% of thoracic trauma occurs as part of a multisystem injury, the physician must also consider head, neck, and intra-abdominal injuries when evaluating a child with chest trauma An overview of the approach to the child with blunt thoracic trauma is shown in Figure 115.1 KEY POINTS