Various unforeseen situations can happen in our lives. No one can be insured against an accident. Often, in case of accidents, falls from a height, domestic injuries, or when engaging in combat sports, the chest is damaged.
This is a fairly broad group of injuries, which includes not only rib fractures, but also various injuries to internal organs. Often such injuries lead to significant blood loss, traumatic shock, and respiratory failure, which, in turn, can lead to serious health complications and even death.
All chest injuries can be divided into open and closed
Symptoms of chest contusion
The main signs of a chest contusion are:
- dull pain in the chest, which appears immediately after injury and is especially strongly felt when coughing, taking a deep breath, bending over, or other body movements;
- bruising in the injured area (there may not be a hematoma, but the risk of organ damage remains);
- swelling (increase in volume) of soft tissues.
Damage to the lungs due to a contusion of the sternum manifests itself in the following:
- superficial pain may be accompanied by deeper pain;
- blood pressure decreases, pulse increases;
- the patient experiences shortness of breath and feels short of air;
- lips turn blue, forehead is covered with perspiration;
- the patient may cough up blood.
- heart rhythm disorder
Heart damage due to sternum injury may include:
- angina pectoris - characterized by pain in the heart area;
- infarction-like - the patient experiences shortness of breath, agitation, and fever.
“Learn to save lives!” Injuries to the abdomen and chest.
ABDOMINAL AND CHEST INJURIES FIRST AID
Chest injuries are often observed during road traffic accidents (when the chest hits the steering column, vehicle collisions with a pedestrian, etc.). In this case, fractures and bruises of the ribs are often observed, which are characterized by swelling at the fracture site, sharp pain that intensifies with breathing and changes in the position of the victim’s body. In addition to rib fractures, injuries to the chest are also possible, which may result in a violation of its tightness, which, in turn, leads to sudden disturbances in the functioning of the lungs and heart. Without adequate and timely assistance, this can lead to the death of the victim within a short period of time. Signs of such damage are the presence of a wound in the chest area, through which air is sucked into it during inhalation with a characteristic suction sound; When you exhale, the blood in the wound may bubble. The victim's breathing is rapid and shallow, the skin is pale with a bluish tint.
First aid for fractures and bruises of the ribs:
- Place the victim in a semi-sitting position.
- Monitor the victim’s condition until emergency medical assistance arrives.
First aid for chest injuries:
- Perform initial sealing of the wound with the victim’s palm before applying a bandage.
- Apply a sealing (occlusive) bandage using an airtight material (packaging from a dressing bag or bandage, polyethylene, oilcloth).
- Place the victim in a semi-sitting position, leaning towards the affected side.
- If there is a foreign object in the wound, secure it by covering it with napkins or bandages and apply a bandage.
Abdominal and pelvic injuries. In various incidents, the victim may suffer blunt trauma to the abdomen and abdominal wounds. Blunt abdominal trauma may go unnoticed until internal bleeding causes a sharp deterioration of the condition, while the victims will complain of constant sharp pain throughout the abdomen, dry mouth; Nausea and vomiting may occur; there is a board-like tension in the abdominal muscles; signs of blood loss. In case of abdominal wounds with severe injuries to internal organs, damage to its anterior wall can be both significant and subtle. Therefore, all victims with any abdominal injuries must be examined by a doctor. If there is a penetrating wound to the abdomen, there may be prolapse of internal organs, internal or external bleeding.
First aid:
- Apply a loose bandage to the wound, cover the prolapsed internal organs with sterile napkins.
- Put cold on your stomach.
- Place the victim in a supine position with bent legs.
- If there is a foreign object in the wound, secure it by covering it with napkins or bandages, and apply a bandage to stop the bleeding.
- If the abdomen is injured, it is prohibited to insert prolapsed internal organs into the wound, bandage them tightly, remove a foreign object from the wound, give painkillers, or give water or food to the victim.
Types of chest bruises
Depending on the location of the lesion, chest contusions can be divided into:
- right-sided - risk of lung damage with possible rupture and bleeding;
- left-sided - risk of heart damage and death.
A bruise can be open with superficial wounds or closed, in which internal damage to soft tissues, bones, and organs is noted.
Doctors distinguish 3 degrees of bruises :
- Mild - treatment is possible at home.
- Moderate - complications are possible, so treatment must be carried out on an outpatient basis.
- Severe - hospitalization of the victim is required.
General characteristics of the main types of damage
Bruises, compression and concussions of the chest occur due to strong blows with a blunt heavy object, or sharp compression of the sternum between several hard objects. A bruise is a violation of the structure and vital functions of soft tissues. To a weak degree, it poses virtually no threat to humans. Severe bruises can cause internal hemorrhages with ruptures of tissues and organs. A concussion is accompanied by a severe form of shock in the absence of anatomical disorders. Breathing, blood circulation and pulse are impaired. Compression of the chest causes suffocation, shortness of breath, and disturbances of consciousness.
Open wounds are divided into penetrating and non-penetrating. The first type is more dangerous, as it is associated with a violation of the integrity of the pleural cavity of the lungs. Non-penetrating injuries do not affect the pleural cavity.
Hemothorax is an accumulation of blood in the pleural cavity of the lungs. The pathological condition is formed due to damage to the intercostal vessels. Pneumothorax refers to the accumulation of air in the pleural cavity - it gets there from a damaged lung or from the environment.
Providing first aid to a victim who is suspected or diagnosed with a chest injury can only be adequate if the person providing it has a basic level of medical training, for example, has completed first aid courses, and also has sufficient knowledge and skills to differentiate different types of injuries. Otherwise, there is a high probability of causing even more harm to the person.
First aid for bruised sternum
In case of severe chest injury, you should call an ambulance. Before the team arrives, you need to do the following:
- arrange the victim in a semi-sitting position, ensure him peace;
- apply a cold compress to the damaged area, which will help reduce swelling and hematoma;
- if the pain is severe, give the patient an anesthetic and be sure to inform the arriving doctors about this.
Next, the patient should be treated by a traumatologist. An ambulance employee will decide on the spot whether hospitalization is necessary or recommend contacting a specialist for treatment.
The appointment is conducted by traumatologists
Denis Ivanovich Burmakin - Deputy Director for Medical Affairs, orthopedic traumatologist. Extensive experience in emergency traumatology, pediatric orthopedics, and rehabilitation after injuries.
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Bryukhanov Anatoly Valentinovich - microsurgeon.
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Bryukhanov Vladimir Innokentievich - traumatologist-orthopedist, highest qualification category, Honored Doctor of the Russian Federation, work experience of more than 35 years.
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Zotov Vyacheslav Viktorovich - orthopedic traumatologist.
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Pospelov Yuri Vladimirovich - orthopedic traumatologist.
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Klimov Vladimir Aleksandrovich - orthopedic traumatologist. Operating traumatologist-orthopedist.
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Dmitry Anatolyevich Shcherbovich - orthopedic traumatologist, chiropractor, physiotherapist, first medical category, 13 years of work experience. Head of the rehabilitation department.
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Forms of control:
- Control of knowledge during examination and interview of victims.
- Discussion of supervised victims.
- Solving situational problems.
- Test control.
Etiology and pathogenesis.
The anatomical and physiological features of the structure of the chest create conditions for severe respiratory and circulatory disorders in the event of various injuries. The pathogenesis of these disorders is based on compression of the lungs and mediastinum by air or blood, the shockogenic pleuropulmonary zone, anemia, and pathological respiratory mechanisms. Chest injuries are very often complicated by shock, which is aggravated by hypoxia and hypercapnia.
The classification of chest injuries is shown in Figures 25.1 and 25.2.
Classification of chest injuries (E.L. Wagner, 1981)
.
Rice. 25.1. Classification of closed chest wounds.
Rice. 25.2. Classification of penetrating chest wounds.
Diagnosis of chest contusion
In case of a chest bruise , we advise you to contact the KIT multidisciplinary medical center for examination and to eliminate the risk of serious injury to internal organs. Our doctor will collect anamnesis, find out the circumstances of the injury and give recommendations for treatment.
Palpation of the damaged area will determine the integrity of the bones.
X-ray will confirm or refute the initial diagnosis and will make it possible to identify rib fractures. If there is insufficient information, we will conduct a computed tomography scan, which will help assess the condition of the bone tissue.
To rule out the risk of internal organ damage or determine the severity of injury to the lung or heart, your doctor may also order a magnetic resonance imaging ( MRI ) scan.
Remember that you should not leave everything to chance and neglect a thorough diagnosis and examination in the clinic. A severe injury can cause arrhythmia and other heart rhythm disorders, which will cause serious illness in the future.
Complications of rib fractures
Rib fractures, especially multiple ones, are often complicated by hemothorax, closed and valve pneumothorax, and subcutaneous emphysema.
Hemothorax
Hemothorax is the accumulation of blood in the pleural cavity, which leaked from damaged muscles or intercostal vessels, when wounded by fragments of the rib of the parietal pleura. There is less bleeding when the lung parenchyma is damaged, but then, as a rule, hemothorax is combined with pneumothorax, i.e. hemopneumothorax occurs. Depending on the degree of bleeding, hemothorax can be small - it occupies only the pleural sinus (100-200 ml of blood), medium, and does not reach the level of the lower angle of the scapula (300-500 ml). Total hemothorax (1-1.5 l) is extremely rare.
The level of hemothorax is determined by percussion and x-ray with the patient in an upright sitting position. During percussion, the upper limit of dullness of the percussion sound is especially clearly demarcated against the background of the box sound of pneumothorax. On the radiograph, the hemothorax area is darkened with a pronounced horizontal upper border. Under local anesthesia, the diagnosis is clarified by puncture of the pleural cavity. If the hemothorax is small, sometimes it is not possible to suction the blood from the sinus.
Symptoms . A small hemothorax has no special signs, and the clinical symptomatology is dominated only by signs characteristic of rib fractures. But the dynamics of hemothorax need to be monitored, since it can increase. Moderate, especially total, hemothorax compresses the lung, hypoxia, shortness of breath, sometimes hemodynamic disturbances, etc. appear. With hemothorax, body temperature predominantly increases (38-39 ° C).
Treatment . Considering that hemothorax is one of the complications of rib fractures, the patient is treated comprehensively. As for hemothorax, with minor hemorrhage into the pleural cavity, the blood gradually resolves, although puncture is done to minimize the amount of blood. Due to reactive inflammation of the pleura and blood residues, the pleural cavity becomes obliterated over time.
In case of significant hemothorax, blood from the pleural cavity is immediately sucked out with a puncture needle, since after some time it can settle into a clot, and then it is necessary to perform an operation.
If after the puncture blood appears again, which should be regarded as unstoppable bleeding from damaged vessels, the patient undergoes a thoracotomy - a surgical intervention to stop the bleeding. But before that, a puncture and a Ruvilois-Gregoire test are performed to determine whether the blood is fresh. Fresh blood obtained in a test tube in air quickly settles into a clot, but stale blood does not settle. Then you can limit yourself to repeated puncture.
There are cases when exudative pleurisy develops after hemothorax. Then the diagnosis is clarified by puncture and conservative treatment is carried out (repeated punctures, drug therapy, etc.).
Closed and valve pneumothorax
If the visceral pleura and parenchyma are damaged during inspiration, air from the lung enters the pleural cavity, where normally there is negative pressure (0.039-0.078 kPa, 4 8 mm water. in.).
The elastic lung tissue contracts and the lung collapses - a closed pneumothorax is formed. If, in addition to air, blood from damaged intercostal vessels or lung parenchyma enters the pleural cavity, hemopneumothorax is formed.
There are cases when the lung is injured so that pleural or lung tissue hangs over the rupture site. Then, when you inhale, air enters the pleural cavity, and when you exhale, this tissue, like a valve, closes the opening to the lungs and does not allow the air to escape - a valve pneumothorax is formed.
With each inhalation, the amount of air in the pleural cavity increases, its pressure rises sharply (tension pneumothorax), which leads to compression of the lung and displacement of the mediastinum. Disorders of gas exchange and hemodynamics appear quite quickly. The general condition of the patient becomes severe, severe shortness of breath, cyanosis of the skin and mucous membranes, and tachycardia occur. As a result of sudden suffocation, the patient develops fear and severe psychomotor agitation.
The presence of pneumothorax is determined by percussion by the characteristic box sound, comparing it with the healthy half of the chest. On auscultation, breathing is weakened, and with a collapsed lung, it cannot be heard. The radiograph shows a clear contour of the collapsed lung against the background of clearing of the pneumothorax area. Puncture of the pleural cavity clarifies the diagnosis; moreover, with valvular tension pneumothorax, air comes out through the needle under pressure.
Treatment . In case of closed pneumothorax, regardless of its degree, air is immediately sucked out from the pleural cavity. This, firstly, improves the general condition of the patient, and, secondly, with prolonged pneumothorax the lung becomes rigid, and then it is more difficult to straighten it.
If for hemothorax the chest is punctured in the lower section, then for pneumothorax it is punctured in the upper, mainly in the second intercostal space along the midclavicular line. The air is sucked out using a Janet syringe or a triampulle system. If the pressure in the pleural cavity becomes negative, then the triampulle system is excluded. Lung expansion is controlled by percussion and x-ray.
The general condition of a patient with a closed valve pneumothorax is so severe that he should immediately, directly at the scene of the accident, perforate the chest wall (with a thick injection needle) - convert the closed pneumothorax into an open one. After the puncture, air is immediately released from the pleural cavity under pressure. And then the pressure in the cavity is equalized with atmospheric pressure, and the patient’s general condition improves. Choking is significantly reduced. After a few hours, with collapsed lungs, the “valve” can be stuck with fibrin, and a regular closed pneumothorax is formed. In these cases, the air from the pleural cavity is sucked out using a triampulle system. If the lung has expanded, then the triampulle system is not excluded, but negative pressure is maintained in the cavity and monitored for a day or two. The system is turned off only when they are sure that the valve has closed and there is no air in the pleural cavity. This is confirmed by percussion, auscultation and x-ray.
If the amount of air sucked out exceeds the nominal volume of the pleural cavity, this indicates that air continues to flow from the damaged lung. In this case, the pleural cavity is drained using the Bulau method .
Execution technique . A finger of a surgical glove is hermetically secured to one end of a sterile rubber tube (diameter 5 mm and length 60-70 cm), the top of which is cut along the length by 1.5-2 cm. Thoracentesis is performed and the second end of the tube is inserted into the pleural cavity, fixed, sealed skin wound with a suture. The finger is dipped into a sterile jar filled with an aqueous solution of an antiseptic substance (furacilin (1: 500), etacridine lactate (1: 1000), etc.).
During inhalation, the tip of the finger collapses in the solution and closes the hole in it, preventing the solution from being sucked into the tube. When you exhale, the chest collapses and air escapes through the tube into the jar. This is how suction drainage works. After a day or two, when the valve in the lungs closes, negative pressure is created in the pleural cavity, and the lung expands, the drainage stops working, and after a day it is removed.
If the valve does not close after a few days, this indicates significant damage to the lung, and the patient is operated on. After elimination of pneumothorax, patients with rib fractures are treated according to general principles.
Subcutaneous emphysema
If there is pneumothorax and damage to the parietal pleura or mediastinum, then air from the pleural cavity through the wound enters the soft tissues of the chest or mediastinum, moves through the interfascial spaces into the subcutaneous tissue of the shoulder girdle, neck and face. Subcutaneous emphysema is especially pronounced with valvular pneumothorax.
Characteristic signs of subcutaneous emphysema: swelling in the area of air accumulation, and upon palpation - a specific crunch in the subcutaneous tissue (“walking in the snow”) due to the rupture of bubbles and movement of air. By percussion you can feel the difference in the percussion sound above the emphysema. Air in the soft tissues is also visible on a chest x-ray.
Subcutaneous emphysema gradually decreases, the air is absorbed and no special treatment is required. Only in case of excessive emphysema, when air accumulated under the skin of the neck compresses the veins or trachea, small fasciocutaneous openings with drainage are made above the collarbone, through which the air escapes.