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So chest trauma kills through three mechanisms. Learn the three, and every diagnosis in this lesson slots into one of them.
Failure to ventilate. Air can't move in and out. An open wound, a flail segment, a contusion — the mechanics of breathing break down.
Failure to fill the heart. Blood can't get back to the heart and out to the body. Tension pneumothorax and cardiac tamponade both work this way, just through different physical squeezes.
Exsanguination. The patient bleeds out — a torn great vessel, a shredded lung, a massive hemothorax filling the chest instead of the ground.
Most of these patients need oxygen, ventilation support, a seal over a wound, and a fast ride in. A small number need a needle in the chest right now. Confusing that small group with everyone else causes harm both ways — the needle helps almost no one, and the ones it does help die without it.
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