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S Afr Med J. 1982 Jun 12;61(24):917-9.

Conservative management of blunt chest trauma.


Conservative management of blunt chest trauma reduces morbidity in selected patients. We present a retrospective analysis of 50 patients with blunt chest trauma who were treated in the Respiratory Unit of Groote Schuur Hospital, Cape Town, during 1980. Conservative management was not possible in 21 patients because of severe associated injuries. The remaining 29 patients were treated either with continuous positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP) by face-mask and thoracic extradural analgesia. The conservatively treated patients spent less time in the Intensive Care Unit and had fewer complications. Thoracic extradural analgesia provides optimal pain relief with resultant increase in vital capacity and an improvement in arterial blood gas levels. Current management of blunt chest trauma is directed at early withdrawal of continuous ventilatory support as soon as this can be replaced either with thoracic extradural analgesia and CPAP by mask, or with CPAP by mask alone.

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