Trauma: Approach to Thoracic Trauma

Thoracic Trauma

“Mediastinal/Cardiac Box”

  • Classical Borders:
    • Anterior Borders: Nipples (Lateral), Clavicles (Superior) & Xiphoid (Inferior)
    • Posterior Borders: Scapula (Lateral), Trapezius (Superior) & Scapular Tip (Inferior)
  • Should Raise Concern for Mediastinal Injury (Cardiac, Esophagus & Trachea)
  • *Serves More Historical Significance but Should Still Raise Concern – Think “Outside the Box” as Bullets Do Not Respect Anatomic Landmarks

General Orders to Consider

  • Within Box Orders
    • Pericardial Window/FAST
      • Positive: Median Sternotomy & Repair
    • Bronchoscopy
    • Esophagoscopy or Esophagram
  • Strongly Consider Chest Tube if Patient Requires ETT
  • Chest Below T4/Nipple Line – Considered Both “Thoracic” & “Abdominal”

Thoracic Incisions

Mediastinal “Box”