Seamon et al developed a protocol for handling a patient with a penetrating thoracic injury. This is intended to expedite patient discharge from a busy urban emergency department while maintaining patient safety. The authors are from Temple University in Philadelphia.


Patient selection: penetrating chest wound (knife or small caliber gunshot)


The patient undergoes an appropriate intervention if:

(1) the patient is symptomatic at presentation

(2) the initial chest X-ray show pneumothorax or hemothorax


If the patient is asymptomatic and has a negative initial chest X-ray, then a second chest-Xray is performed 3 hours later.


If the followup chest X-ray is positive for pneumothorax or hemothorax then the patient undergoes the appropriate intervention.


If the followup chest X-ray is negative for pneumothorax or hemothorax, then the patient can be discharged.


The protocol may need to be adapted to patient-specific factors such as:

(1) the ability to return to the emergency room if symptoms develop

(2) the chance that clothing or environmental debris may have been driven into the wound

(3) the proximity to the heart or major blood vessels

(4) the patient is intoxicated or taking a stimulant drug


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