Picture quiz: Chest trauma
A 35 year old man presented at the emergency department with a penetrating chest injury. He was involved in an alleged assault that resulted in a screwdriver being thrust into his sternum. He had no other associated injuries. Initial assessment showed that he was haemodynamically stable with no signs of respiratory distress. The screwdriver was left in place. Chest radiographs taken in the emergency department confirmed the penetrating chest injury (fig 1).
Chest trauma can be broadly divided into blunt and penetrating, with penetrating trauma accounting for more than a quarter of cases. Blunt chest trauma is commonly caused by steering wheels and in pedestrians hit by road vehicles, causing acceleration or deceleration and compression injuries.
Penetrating trauma can be further categorised as low, medium, and high velocity. Low velocity injuries include stabbing, such as in this case. Medium velocity injuries are caused by handguns and air powered pellet guns.