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    Diaphragmatic Trauma

    Diaphragmatic Trauma is a topic covered in the 5-Minute Emergency Consult.

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    Emergency Central

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    Basics

    Description

    • Penetrating injury:
      • Violation of the diaphragm by penetrating object (most commonly stab and gunshot wounds)
      • May involve any portion of diaphragm
      • Smaller defect compared with blunt injuries (more likely to be missed)
    • Blunt injury:
      • Increased intra-abdominal or intrathoracic pressure is transmitted to diaphragm, causing rupture.
      • Usually due to motor vehicle crashes
      • Injuries are more commonly left-sided:
        • Left hemidiaphragm has posterolateral embryologic point of weakness.
        • Right hemidiaphragm is protected by liver.
        • Injuries are larger than with penetrating injury (frequently between 5 and 15 cm in length).
    • Diaphragmatic defects do not heal spontaneously because of pleuroperitoneal pressure gradient:
      • May exceed 100 cm H2O during maximal respiratory effort
      • Promotes herniation of abdominal contents through rent in diaphragm and into chest

    Epidemiology

    Incidence
    Uncommon; <1% of all traumatic injuries

    Etiology

    • Lateral torso impact is 3 times more likely to result in ipsilateral diaphragmatic rupture than frontal impact.
    • Suspect diaphragmatic injury:
      • Penetrating trauma to thoracoabdominal area
      • Injuries that cross plane of the diaphragm

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    Citation

    Rosen, Peter, et al., editors. "Diaphragmatic Trauma." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma.
    Diaphragmatic Trauma. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma. Accessed April 25, 2019.
    Diaphragmatic Trauma. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma
    Diaphragmatic Trauma [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Diaphragmatic Trauma ID - 307469 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -