Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
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- 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
Uncommon; <1% of all traumatic injuries
- 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