Last reviewed: 27 Sep 2021
Last updated: 16 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain
  • dyspnoea

Other diagnostic factors

  • signs of impaired oxygenation
  • paradoxical chest wall motion

Risk factors

  • blunt chest trauma
  • cardiopulmonary resuscitation (CPR)
  • physical abuse in children
  • osteoporosis
  • participation in sport
  • primary bone tumours
  • metastatic bone tumours

Diagnostic investigations

1st investigations to order

  • CXR
  • CT chest
  • extended focused assessment with sonography

Investigations to consider

  • CT of head, cervical spine, abdomen, and pelvis
  • echocardiography
  • skeletal survey and CT head (children)

Treatment algorithm

Contributors

Expert advisers

Michael Barrett, MBChB, FRCS (Tr & Orth), PG Cert Med Ed

Consultant Trauma and Orthopaedic Surgeon

Cambridge University Hospitals NHS Foundation Trust

Cambridge

UK

Disclosures

MB is a director of Orthohub.xyz, an online education platform for orthopaedic surgeons. Orthohub.xyz receives sponsorship from the healthcare industry.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Peter Cundy, MBBS, FRACS

Associate Professor

Discipline of Orthopaedics & Trauma

University of Adelaide

Paediatric Orthopaedic Surgeon

Women's and Children's Hospital

Adelaide

Australia

Nicole Williams, BMedSc (hons I), BMed, Grad Cert Sports Med, FRACS (Ortho)

Associate Professor

Orthopaedics and Trauma

University of Adelaide

Head of Orthopaedic Surgery and Major Trauma Service Co-Director

Women's and Children's Hospital

Adelaide

Australia

Peer reviewers

Douglas West, BSc(Hons), MB, ChB, FRCS(CTh), Dip Epidemiol (Lond)

Consultant Thoracic Surgeon

University Hospitals Bristol and Weston NHS Foundation Trust

Bristol

UK

Biography

DW is Thoracic Surgery Audit Lead and Audit Committee Co-Chair, the Society for Cardiothoracic Surgery; Cardiothoracic National Clinical Lead, Getting it Right First Time (GIRFT), NHS England Improvement; Board Member, Cardiothoracic Specialty Specific Group, the Royal College of Surgeons of Edinburgh. DW is Co-Chair, Lung Cancer Guideline Update Committee, NICE (2019) and Member, Lung Cancer Quality Standards Committee, NICE (2019). DW has been a member of the NHS England Clinical Expert Group on Lung Cancer.

Disclosures

DW has received speaker’s fees from AstraZeneca for events related to lung cancer care; research grants and speaker’s fees from Medtronic, a medical devices company; speaker’s fees and travel expenses from Ethicon, a medical devices company, for events related to training in thoracic and spinal surgery; and reimbursement of travel expenses from Bristol Myers Squibb for events related to lung cancer. DW has edited patient education materials (unpaid) for the Roy Castle Foundation, and has been reimbursed by it for travel expenses incurred attending meetings of the NHS England Clinical Expert Group in Lung Cancer.

Editors

Emma Quigley,

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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