Blunt and penetrating chest trauma with concomitant COVID-19 infections: Two case reports

Abstract

Background: We present two patients: one with a blunt and one with a penetrating chest trauma mechanism and both with concomitant COVID-19 infections. Findings: The first patient is a 23 year old previously healthy male who presented to a Level 1 trauma center following a motor vehicle collision with blunt chest trauma and respiratory failure. The second patient is a 30 year old previously healthy male who presented to a Level 1 trauma center for a stab wound to the anterior chest with a right ventricular injury. Both patients were incidentally found to be COVID positive. We discuss the impact of COVID positivity on management considerations in these trauma patients. Conclusion: Concurrent COVID infection in trauma patients with respiratory failure after pulmonary trauma can obscure the cause of the respiratory failure. At the time of this writing, management of both is similar, COVID-specific therapeutic agents are being investigated, and steroids carry the best evidence. Superimposed bacterial co-infections should be treated. Although timing of tracheostomy is institution-specific, when indicated it is still performed. COVID infection is often associated with a hypercoagulable state in trauma patients who are already at higher thrombotic risk. In keeping with normal practice after hemorrhagic resuscitation in trauma patients, an early aggressive initiation of prophylactic anticoagulation continues to be prudent. The benefit of empiric therapeutic anticoagulation is not yet known.

Keywords

• Chest trauma
• Coronavirus
• COVID-19
• Coagulopathy
• Lung contusion