Emergency thoracotomy in the management of trauma.

The role of emergency room thoracotomy in the management of trauma remains poorly defined despite an increase in its use. Most authors agree that the procedure is effective in the treatment of penetrating thoracic injuries, while its benefit in penetrating injuries below the diaphragm and in blunt trauma has not been established. The best outcome can be expected in patients who have sustained penetrating cardiac and thoracic injuries. Penetrating abdominal wounds that are severe enough to require thoracotomy in the emergency room fare less well; those patients who suffer from blunt thoracoabdominal injuries are least fortunate. The anatomic location and mode of injury greatly influence the outcome of these patients and are useful in determining when to perform this procedure.