O'Connor et al evaluated patients with penetrating chest trauma. They identified findings associated with the need for thoracotomy and findings predictive of outcome. The authors are from the Shock Trauma Center at the University of Maryland in Baltimore.

Patient selection: penetrating chest trauma


Frequency of thoracotomy: 15%


Clinical findings predictive of operating room thoracotomy within 6 hours of admission:

(1) acidosis (low pH, based deficit, elevated blood lactate) with inadequate tissue perfusion

(2) persistent hemorrhage associated with the chest wound


There was considerable discordance between the level of shock and the admission blood pressure. Significant shock can occur with normal or near normal systolic blood pressures.


Clinical findings associated with mortality:

(1) pneumonectomy

(2) damage control thoracotomy

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