Abstract
As in other causes of trauma, evaluation of the patient with a penetrating thoracic injury begins with the primary survey of Advanced Trauma Life Support (ATLS). In the case of penetrating chest trauma, this algorithmic assessment may be interrupted by need for tube thoracostomy or thoracotomy, depending on the status of the patient. First, a chest radiograph should be obtained. Hemothorax should be drained via tube thoracostomy promptly. Small pneumothorax can be observed in select patients with no other injuries; however, the threshold to place a chest tube for pneumothorax should be low. A chest injury below the level of the nipple (spinal level T4) is considered a thoracoabdominal injury, and injury to the abdominal viscera and diaphragm must also be considered. For the hemodynamically unstable patient with penetrating chest injury, the trauma team must act quickly to determine the etiology.