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Background: Tube thoracostomy (TT) is central in the management of chest trauma sufficing in over 80% of cases. As a result the procedure is commonly performed in most emergency departments., Objective: The aim of this study was to assess the efficacy and complications of TT using Advanced Trauma Life Support (ATLS) technique in chest trauma., Methods: This prospective study was done at the Trauma Unit of the University of Benin Teaching Hospital in Nigeria. All patients with chest trauma who needed tube thoracostomy between February 2006 and February 2009 were studied. Data recorded for each patient included injury, mechanism of injury, Glasgow Coma score, revised trauma score, and indications for tube thoracostomy. Chest radiographs were obtained preinsertion, post insertion and post extubation for all the cases. Patients were monitored for tube thoracostomy complications., Results: Of 9415 trauma patients seen during the period 105 patients had tube thoracostomy but only 70 (56 male, 14 female) had adequate data for analysis. Seventy-four tubes were passed in the 70 patients with unilateral tubes in 66 (94.3%) and bilateral tubes in 4 (5.7%). Blunt chest trauma occurred in 32 (45.7%) and penetrating chest trauma in 38 (54.3%) of the patients. Simple haemothorax and haemopneumothorax were the commonest indications for tube thoracostomy. Complications recorded include four cases of kinked tubes, four of superficial wound infection and 10 cases of residual haemothorax., Conclusion: Tube thoracostomy in the emergency department using advanced trauma life support principles is effective in chest trauma and associated with few complications.

Background: Management of spleen injuries has undergone evolution over the past few decades., Objective: To assess the challenges of managing splenic injuries in Nigeria., Methods: The medical records of all adult trauma patients with documented injury of the spleen over a two-year period (2006-2008) were reviewed. Data collected included patient demographics, mechanism of injury, injury-arrival time, Revised Trauma Score, abdominocentesis, abdominal ultrasound and CT findings. Treatment received, outcome and length of hospital stay were also documented., Results: Twenty-three patients were managed for splenic injuries during the period under review. These consisted of 21 (91.3%) males and two (8.7%) females. The age range was 16 to 58 years [mean of 29.6(12.2 years)]. The mechanism of injury was blunt in 21 cases and penetrating in two cases with motor vehicle accident being the most common cause of injury. The mean injury-arrival time was 25.2(26.5) hours. Eight patients successfully underwent non-operative management, while 15 had operative intervention. Splenectomy was the most frequently performed procedure. Challenges identified in the management of patients with splenic injuries in Nigeria include delayed presentation, underutilization of CT, unavailability of interventional radiology, inadequate ICUs, limited vaccination, discharge against medical advice and poor follow up., Conclusion: Non-operative management of injuries to the spleen in adults appears promising. The challenges identified need to be addressed in order to deliver optimal care for the victims of spleen trauma.