Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVIII: Wounds and Injuries of the Chest
United States Department of Defense
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Reviewed
Shock and hypoxia, the pathophysiological derangements by which chest trauma kills, result from decreased venous return or inadequate alveolar gas exchange. Decreased venous return is usually a manifestation of exsanguination, thus the paramount importance of controlling bleeding. Inadequate alveolar gas exchange can result from such factors as loss of the usual negative intrapleural pressure, leading to collapse of the lung, and obstruction of the smaller air passages by secretions or blood. The therapeutic goal is to restore normal physiology and thereby to restore cardiac and pulmonary function. Thus is true not only in the immediate post-injury phase, but also later in the course when the surgeon is faced by such chronic complications as trapped lung or the need to reconstruct the chest wall. Salient aspects of common battlefield thoracic problems are considered below.
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