Injuries of a thorax – injuries at which the bones forming the framework of a thorax and/or bodies located in a chest cavity suffer. It is extensive and rather diverse group of traumatic damages including both fractures of edges, and an injury of vitals (lungs and heart). Often injuries of a thorax pose a direct threat or potential danger to the patient's life. Quite often are followed by blood loss of various weight and development of sharp respiratory insufficiency which can develop both at once, and after a while after a trauma. Therefore one and all patients with injuries of a thorax have to go urgently to specialized medical institution for inspection and further treatment which, depending on a type of a trauma, can be either conservative, or quick.
Injuries of a thorax
Injuries of a thorax – the group of damages including injuries of edges, a breast and internals located in a chest cavity. Such injuries can strongly differ both on character, and on weight, however because of potential danger to the patient's life at the initial stage are always considered by doctors as serious, demanding detailed inspection of the patient. This group of injuries differs in a high lethality in the absence of medical care and rather high percent of favorable outcomes at timely delivery of the patient in specialized medical institution. Mortality makes 5-6%, at the same time the majority of fatal cases are the share of open damages (wounds), and also of multiple fractures of edges with a rupture of a lung.
All injuries of a thorax are subdivided into two groups: closed and opened. Distinctive feature of the closed damages is absence of a wound. Such damages share on:
- Concussions. Injuries at which visible morphological changes of a thorax are absent.
- Bruises. Include bruises of edges and soft fabrics, a heart bruise, a bruise of vessels, bruises and ruptures of lungs in this group, and , fractures of a breast, edges and chest vertebras.
- Sdavleniya. Here cases of traumatic asphyxia at which the breast of the patient is squeezed between two blunt objects because of what there is suffocation belong.
At open damages to area of a thorax there is a wound which can be knife, fire etc. Open damages (wounds) are subdivided on:
- Not getting.
- Without internal injury, located in a chest cavity.
- With an internal injury, located in a chest cavity.
- With injury of bones (edges, chest vertebras or breast).
- Without open pheumothorax or with its existence.
- Without open gemotoraks or with its existence.
- Torakoabdominalny trauma (with simultaneous violation of integrity of a chest cavity, a diaphragm and an abdominal cavity).
Taking into account the nature of damage also allocate perforating, blind and tangent wounds of a breast.
In peace time the closed injury of a thorax meets in traumatology much more more often of open. Car accidents (70%), falling from height (23%), production injuries, natural disasters, criminal actions (beating, a fight) or a home accident become its main reasons. Most often at the closed trauma injuries of lungs (60%), edges (45,4%), heart (8%) and a backbone (4,8%) come to light. Other bodies suffer rather seldom. Damages of easy, intercostal vessels, pleurae, bronchial tubes and pulmonary vessels secondary character has more often and develops owing to a travmatization of these bodies the sharp ends of the broken ribs.
Open damages in peace time meet infrequently and usually result from wound cold weapon. The quantity of gunshot wounds sharply increases in wartime. The wounds given by other subject (for example, the sharp metal probe or a piece of fittings) can result from a production trauma, technogenic or natural disaster or accident in life.
Fractures of edges and breast
Fractures of edges usually arise at adult patients. At children and teenagers are observed very seldom owing to extreme elasticity of bone structures. Taking into account the trauma mechanism all fractures of edges can be divided into three groups: indirect, direct and detachable. The largest shift of otlomk and, as a result, high probability of damage of bodies of a chest cavity by the sharp ends of the broken ribs, arises at detachable, double and multiple fractures.
Otlomki of edges can injure not only a lung and a pleura, but also intercostal vessels owing to what there is internal bleeding in a pleural cavity and it is formed . If the sharp end of an edge pierces a lung, air comes out in a pleural cavity, and pheumothorax is formed.
Sharp pain in the place of damage and pain testifies to a fracture of edges at a thorax sdavleniye in the perednezadny direction. Breath becomes superficial. It is easier for patient to be in sedentary, than in lying situation. The main method of tool diagnostics is the X-ray analysis of edges. Treatment consists in elimination of pains, prevention of pneumonia and simplification of breath.
At an uncomplicated fracture of one edge the patient is on out-patient observation. The fracture of two or more edges is the indication for hospitalization. Sick appoint analgetics and physiotreatment, recommend to be in a bed in situation semi-sitting. For the prevention of developments of stagnation in lungs the respiratory gymnastics is surely appointed. At multiple fractures of edges their operational immobilization is made.
Fractures of a breast are rather rare. Are followed by the pain amplifying at cough and deep breath. The palpation is sharply painful. For confirmation of the diagnosis carry out a side X-ray analysis of a breast. Treatment is performed in the conditions of a hospital. At changes without shift rest and the anesthetizing medicines is appointed. At shift the repozition on a board is carried out.
Bruises, concussions and sdavleniye
Similar injuries of a thorax meet less than fractures of edges and arise owing to blow by a blunt object or the forced sdavleniye between two large blunt objects. The bruise of a thorax is followed by a small hematoma and moderate pain. Usually do not demand special treatment. In some cases at a severe bruise can arise the extensive hemorrhage in fabric or cavities of a thorax which sometimes is followed by a rupture of bodies and fabrics. Such trauma belongs to the category of heavy, demands urgent hospitalization and can end with the death of the patient.
At concussion of a thorax extremely heavy shock in the absence of anatomic changes is observed. Condition of the patient heavy, breath uneven, painful, superficial. The pulse which is speeded up, uneven, almost inaudible. Extremities are cold, tsianotichny. Immediate hospitalization, absolute rest and inhalation of oxygen under pressure is necessary.
At a thorax sdavleniye the respiratory movements are broken. Blood flows from nadplechiya, the top part of a breast, a neck and the head. Suffocation develops. Consciousness violations are possible. Skin of the listed departments of a body becomes blue, on it, and also on a conjunctiva and on a mucous oral cavity numerous small hemorrhages (ekhimoza) are formed. The decollete symptom – hypostasis and a tsianotichnost of the top part of a trunk comes to light. The temporary loss of sight and hearing caused by hemorrhages and an optic nerve, a retina, an eyeball and an inner ear is possible.
The patient is hospitalized, recommend to be in rest in a semi-sitting position. For elimination of a pain syndrome carry out novokainovy vagosimpatichesky blockade. Carry out sanitation of airways, oxygenotherapy and, in certain cases – artificial ventilation of lungs.
At not getting injuries of a thorax a condition of patients satisfactory. Treatment consists in imposing of a bandage or ushivaniya of a wound. At the getting wounds the condition of patients can vary considerably and depends on absence or existence of haemo pheumothorax and the accompanying internal injuries and a bone framework.
at such injuries pheumothorax – because of penetration into a pleural cavity of air from a wounded lung develops owing to bleeding in a pleural cavity from the damaged vessels of a lung and a chest wall. At wound of a lung the blood spitting, and hypodermic emphysema is observed. For specification of the diagnosis the thorax X-ray analysis is carried out. Treatment is surgical. Patients are hospitalized in specialized office where thoracic surgeons in the emergency order carry out operation and ushivany wounds. The volume of intervention depends on the nature of a trauma.
(a blood congestion in a pleural cavity) it is formed at bleeding owing to damage of intercostal vessels, a lung or an internal chest artery. Allocate small (less than 500 ml), average (from 500 to 1000 ml) and big (more than 1000 ml) . At small the condition of the patient does not suffer or suffers slightly. Perhaps conservative treatment. At an average gemotoraks the condition of the patient moderately or slightly worsens, breath becomes frequent. Both conservative treatment, and a pleural puncture can be required.
At a big gemotoraks shock, violation of haemo dynamics, wrinkling of a lung and shift of bodies of a sredosteniye is observed. Skin of a sick tsianotichn, pulse it is speeded up, the breath which too is speeded up superficial. The position of a body – compelled sedentary, with a support on hands. The pleural puncture, or if it accrues, – a torakotomiya is necessary for identification and elimination of a source of bleeding. All patients with gemotoraksy are without fail hospitalized. Observation includes repeated roentgenoscopic or radiographic researches for assessment of dynamics and definition of further tactics of treatment.
Pheumothorax is a congestion of the air getting into a pleural cavity from the injured lung or from the external environment. Allocate three types of pheumothorax: closed, opened and valvate. At the closed pheumothorax the wound is closed by soft fabrics. The amount of air is limited and does not increase. A small amount of air resolves independently, at moderate the pleural puncture can be required.
Open pheumothorax arises at thorax wounds. Its distinctive sign is existence of the message between a pleural cavity and the external environment. During a breath air gets through a wound, during an exhalation – comes out it. The lung is gradually fallen down. It is necessary ushivany wounds and a puncture or drainage of a pleural cavity. At the accruing (valvate) pheumothorax air gets into a pleural cavity, but then does not come out it. The condition of the patient quickly worsens. The accruing disorder of breath, short wind, suffocation, tachycardia, cyanosis mucous and skin is noted. Immediate drainage of a pleural cavity is required.
Besides a lung sdavleniye on the party of damage pheumothorax causes balloting of a sredosteniye – the pendulum movement of bodies at breaths and exhalations. Heart and vessels are displaced, inflow of blood to heart decreases. It makes heavier a condition of the patient even more. All patients are hospitalized. Emergency measures are taken for elimination of pheumothorax. In the subsequent dynamic observation is carried out, repeated roentgenoscopies of lungs or a X-ray analysis are carried out.