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Closed uncomplicated chest injuries. Treatment of open wounds

Bruises chest rarely pass without leaving a trace. Usually to typical symptoms– pain, “bruising” and swelling – the injury clinic is added internal organs: interruptions in heart function, shallow breathing, hemoptysis, etc. Such symptoms indicate damage to the heart and lungs, which threaten the patient with death. Statistically, every 15th case of bruise occurs in the chest. However, such damage is rarely isolated: it usually occurs against the background of bruised wounds of the limbs or head.

What's special?

The rib cage is a bone frame necessary to protect vital important organs: heart, lungs and blood vessels. In case of bruises of the chest, its deformation with subsequent traumatization of the intrathoracic organ complex is possible. Thus, rib fractures may be accompanied by a closed pneumothorax (rupture of the lung with accumulation of air in the pleural cavity) or hemothorax (when blood is found under the pleura instead of air).

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If fractures of the ribs, sternum or thoracic vertebrae are suspected, use X-ray examination or computed tomography. To determine the integrity of organs or check the contents of the pleural cavity, it is prescribed ultrasound diagnostics. Magnetic resonance imaging can confirm vascular ruptures or the presence of internal hematomas.

In some cases, thoracoscopy is used - an examination of the chest organs using optical equipment (thoracoscope). At in serious condition The patient undergoes a therapeutic and diagnostic procedure - thoracotomy - opening the chest for the purpose of examination and urgent surgical intervention.

Treatment

Treatment of chest contusions begins with emergency first aid. So, the patient must be provided with complete rest, isolated from noise, cold and other irritants. It should be applied to the site of injury cold compress for 20 minutes every 5 hours. 3-4 hours after the injury, a pressure bandage must be applied to the rib frame. To do this, the patient is asked to inhale, then they are applied in dense rows. elastic bandage. At the same time, if there are scratches or abrasions, they are pre-treated with an antiseptic.

It is worth remembering that from the second day after the injury, cold is replaced with heat. The mechanism for applying the compress remains the same.

The most preferable position is the patient sitting or half-sitting with support against the wall. To relieve pain (before going to the hospital) and prevent shock, the patient is given analgesics (Baralgin, Ketanov), but only a doctor can prescribe drugs.

Medications

Drug therapy should be aimed at reducing inflammation, swelling and pain. Thus, painkillers (Analgin) and non-steroidal anti-inflammatory drugs (Nurofen, Meloxicam) are used. To reduce swelling, it is possible to use enzyme agents (Phlogenzyme).

As a local effect, anti-inflammatory ointments (Voltaren, Zhivokost) are used, as well as decongestant gels that accelerate the resorption of bruises (Troxevasin, Heparin ointment).

Surgical intervention

For complications of chest contusion (pneumo- or hemothorax, reflex cardiac arrest, subcutaneous emphysema or thromboembolism), appropriate surgical treatment is required.

So, with pneumothorax, drainage is installed in the pulmonary membrane (pleural cavity) at the level of the second intercostal space. The same tactics apply to hemothorax, but the drainage tube is installed lower, which is due to the physical fact: the liquid (blood) is “heavier” than air.

Subcutaneous emphysema, when it grows rapidly, is eliminated by small incisions in the skin. And pulmonary embolism requires the use of heparin and/or surgical removal thrombus (thromboembolectomy).

Reanimation

Cardiac arrest requires emergency treatment cardiopulmonary resuscitation. In “field” conditions this is only indirect massage heart, while the hospital uses a full arsenal of equipment and medications (Adrenaline, Atropine).

This is interesting! Contrary to popular belief imposed by Hollywood movies, a defibrillator does not “start” the heart. This device is necessary only in cases of fibrillation - frequent and inadequate contraction of the ventricles (as indicated by the name of the device).

Rehabilitation

As rehabilitation activities applies physical therapy, as well as massage. During night sleep, it is recommended to raise the head of the bed or place a pillow under top part torso. At night, you can also wear a bandage on the chest area.

Traditional methods

For mild chest contusions, symptomatic therapy can be used traditional methods treatment:

Soap. After grating the soap on a fine grater, mix it with chicken yolk until a thick mass forms. Apply the mixture to the bruised area in the morning and evening.
Herbal collection. Horsetail, knotweed, bearberry, bean pods, hernia grass, cornflowers and birch buds take in equal quantities (a tablespoon), chop and pour a glass of alcohol. Leave the tincture for three days, then apply compresses to the bruise in the morning and evening.
Vinegar. Mix vinegar into the same amount of honey. Soak in the resulting mixture cotton fabric and apply to the damaged area. Change the bandage twice a day.
Horseradish. Wrap grated horseradish root in gauze and apply to the bruised area in the morning and before bed.

Use similar methods Treatment needs no more than a week. If symptoms do not subside during this time, you should immediately consult a doctor. If traditional methods bring relief, you can continue therapy until the symptoms disappear completely.

Prevention

proper equipment and insurance when working at height (climbers, installers);
compliance with the rules traffic to prevent transport accidents;
following labor regulations and safety precautions at work;
avoiding domestic disputes (fights and attacks);
timely evacuation during wartime;
the use of equipment and grouping during classes is potentially dangerous species sports: skiing, cycling or martial arts.

To prevent possible complications from a chest contusion (including death), you must refrain from self-medication and consult a doctor in a timely manner!

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Approximately 10 percent of people with domestic chest injuries are admitted to traumatology. In this case, victims may experience various injuries to the body, it all depends on the mechanism of injury, its nature, as well as the intensity of the force on the person’s chest.

Bruises and injuries can be closed or open. If the integrity of the skin is not broken, then the injury to the sternum is called closed. If the patient received a chest injury with an open wound, such an injury is called an open injury. The latter, in turn, is divided into a wound that does not penetrate the chest cavity (the integrity of the perital pleura is preserved in the victim), as well as a penetrating wound, that is, the victim has a penetrating wound into the pleural cavity.

Closed and open injuries chest can be with or without bone fractures. There may also be damage to internal organs located behind the chest.

For any of listed types injuries, the depth and rhythm of breathing in a person is disrupted, the victim cannot clear his throat normally, which, in turn, leads to hypoxia.

Blunt chest injuries closed type may result from impact, compression or shock. The nature and extent of damage depend on the intensity of the injury and the mechanism of action on the affected area.

Chest contusions

Most often, traumatologists encounter closed chest injuries with bone fractures. If a person is hit in the area soft fabric chest, then a local swelling forms in the damaged area, the patient complains of pain, and a subcutaneous fluctuating hematoma also forms on the body. As a result of hemorrhage into the muscles, the victim can only breathe superficially, because deep breath significantly enhances painful sensations. To make an accurate diagnosis, medical workers it is necessary to examine the lungs using fluorography.

As first aid for a chest injury, a person is prescribed painkillers (most often novocaine blockade). The patient also needs to undergo a series of thermal procedures, and a few days later do breathing exercises.

If the blood that has accumulated in the area of the hematoma does not resolve, the surgeon will need to make a skin incision. A person becomes able to work after approximately 21 days of treatment.

Chest concussion

A minor concussion resulting from chest injuries (ICD-10 assigns codes S20-S29 to them) can be completely without consequences. The patient will only briefly, after physical contact, feel a lack of air, as well as deterioration in breathing. After some time, the body recovers and returns to normal rhythm life.

Severe concussions are characterized by hemorrhage into internal organs, accompanied by slight shock. The patient’s condition after the injury is extremely serious, he has cold extremities, rapid pulse and breathing. Sometimes such injuries lead to death. To save a person, you need to resort to intensive care. If necessary, you must immediately resuscitation measures, after which health workers should resort to symptomatic therapy.

Bone fractures

Rib fractures most often occur due to direct trauma to the chest. This could be a strong pressure from a massive object or a sharp blow. IN medical practice Double fractures also occur. If the chest is compressed in the anteroposterior direction, several ribs located in the axillary line may break at once. When the chest is impacted from the side, the bones of the paravertebral line are injured.

Bilateral rib fractures most often occur after a severe traffic accident or during a natural disaster, such as an earthquake, when victims are trapped under the rubble of buildings. Such injuries are often aggravated by the fact that the sharp end of a broken bone can damage blood vessels, pierce the lung, and even perforate the pleura.

Symptoms of a rib fracture

Victims who have received a chest injury usually complain of a sharp and severe pain in places of damage. In this case, the pain increases significantly if the patient takes a deep breath. The condition of the unfortunate person depends on the severity of the injury, the number of damaged bones, the condition of the lungs (their integrity), the amount of blood lost (if the wound is open), as well as the pain shock.

If a person admitted to a medical institution has one rib broken, then his general condition is satisfactory. A person cannot inhale large amounts of air due to pain, is unable to cough, release mucus from the lungs, as a result of which it accumulates in the upper respiratory tract. If a person does not get medical attention soon, they may be at risk of developing pneumonia. Another symptom of a bone fracture in the sternum is hemoptysis.

To provide assistance for chest trauma and rib fractures, it is necessary to find the points where a person feels maximum pain. To find the location of the fracture, you should find the place where the chest easily compresses when pressed, and the pain increases significantly. This is the site of bone injury.

To determine whether a closed chest injury has led to a double fracture of one of the ribs, you should know that during inhalation the damaged area sinks, and when exhaling, on the contrary, it levels out. In this case, the victim feels severe pain and is unable to take a strong breath. This condition negatively affects the breathing pattern and disrupts the functioning of internal organs in the body.

Numerous rib fractures, especially bilateral ones, cause severe respiratory distress, hypoxia, and pleuropulmonary shock. To make an accurate diagnosis, correctly fix the body to fix the fracture, perform an operation to remove bone fragments, the patient must be sent for x-rays and percussion. In the absence of qualified assistance, the patient can quickly develop numerous complications, such as pneumothorax or hemothorax.

Treatment of simple fractures

If the injury results in only one rib, and the victim does not experience any complications, then the attending physician will prescribe a pain reliever. It is also necessary to take measures to improve breathing conditions. The patient must take medications that serve to prevent pneumonia.

The patient in the hospital is moved to a bed in a semi-sitting position. To alleviate suffering, the patient is given a local blockade with a Novocaine solution, and analgesics are also used. After the painkillers have taken effect, chest excursion improves significantly, breathing becomes smoother and deeper. The patient is able to cough. The blockade should be repeated several times.

After several days of rest, the patient is sent to therapeutic exercises, as well as symptomatic therapy.

Thanks to modern methods Treatment in an injured patient, the ribs grow together within a month. Full recovery the body occurs 2-3 months after injury.

Treatment of multiple fractures

For fractures of four or more ribs, doctors perform complex treatment which is carried out depending on the severity of the injury. To ensure immobility of the patient, a thin vascular catheter is inserted into the paravertebral area, piercing the skin with a needle. Such a tube is glued to the patient’s body with a plaster, the second end is brought out to the area of the shoulder girdle. If the victim feels acute pain, then about 20 ml of an anesthetic (usually a Novocaine solution) is injected into him through a catheter. Depending on the severity of the injury, a drug that helps a person relax is used up to 5 times a day.

If a patient experiences respiratory distress due to severe trauma to the chest organs, then in this case doctors use a vagosympathetic blockade according to A.V. Vishnevsky, and also conduct intensive therapy. Sometimes resuscitation is required, namely intubation and mechanical breathing.

If a person has double rib fractures during the examination of bone images, then the injured bones are fixed with Kirschner wires, which the surgeon passes through the skin. In some cases, a metal frame made of knitting needles is fixed on the sinking part of the sternum. Securely fixed ribs grow together within a few months.

For complex treatment of the victim, oxygen therapy is used, antibiotics are prescribed, and, if necessary, mucus is sucked out from the trachea.

Possible complications

Multiple fractures in the chest area are often accompanied by complications, such as valvular pneumothorax, hemothorax, and subcutaneous emphysema.

What is hemothorax

Hemothorax is an accumulation of blood in the pleura that has flowed from damaged muscles or intercostal vessels.

When the lung parenchyma is damaged, much less blood is released. However, hemothorax can be combined with pneumothorax, resulting in hemopneumothorax. Hemothorax is divided into several levels depending on the amount of bleeding:

Total, which is extremely rare. With this disease, up to 1.5 liters of blood is released.
With average hemothorax, blood forms in the area of the scapula. The volume of accumulated liquid reaches 0.5 liters.
Small is characterized by the accumulation of no more than 200 ml of blood in the pleural sinus.

It is possible to determine the level of hemothorax using x-ray or percussion.

Symptoms of hemothorax

A small accumulation of blood is quite difficult to detect, because special signs this disease does not occur. At visual inspection Only signs of rib fractures are clearly visible on the patient’s body. However, if hemothorax is not detected in time, it can quickly develop into a more complex disease.

As a result of the accumulation of blood in one place with average hemothorax, one of the lungs is compressed, which leads to hypoxia, severe shortness of breath, and sometimes hemodynamic disturbances are recorded in the patient. Often the victim’s body temperature rises to 39 degrees.

Treatment options

Hemothorax is one of the complications resulting from a rib fracture, so the patient is prescribed complex treatment. If there is a small accumulation of blood, it will resolve on its own over time, but a puncture is still done to minimize the amount of blood near the affected area.

If there is a significant amount of stagnant blood, it should be immediately removed from the body using a special needle. If this is not done in time, the liquid may settle into a clot, and the patient will have to be operated on.

If after all the procedures blood accumulates again, then a diagnosis of “bleeding from a damaged vessel” is made. In this case, a person admitted to a medical institution is given a puncture and then a Ruvilois-Gregoire test to determine how fresh the stagnant blood is. Next, the patient is moved to the operating table for a thoracotomy (opening the chest).

Sternum fracture

This injury usually occurs after receiving direct trauma. Most often, bone fractures occur in the place where the handle meets the body of the sternum; sometimes the bones crack at the site of the xiphoid process. In case of injury in this location, the displacement of bone fragments is insignificant.

Symptoms of sternum injury

The victim complains of pain in the chest, which intensifies significantly when inhaling. The patient also feels sharp pain when coughing. To make a diagnosis, it is necessary to palpate the location of the fracture, and also find out whether there are small bone fragments. An x-ray is also taken in the lateral projection of the chest.

How to treat

The doctor injects 10 ml of Novocaine solution into the place where the fracture is found. If the identified fracture is not displaced and there are no small bone fragments in the human body, then no special treatment will be required. The bones will heal in a month. If displacement of part of the chest after injury is detected, then the patient should be placed on a bed with a shield. It is necessary to place a special medical cushion under the thoracolumbar region so that the bones affected by the injury return to their original position.

If the diagnosis is made correctly and the patient receives qualified assistance, the bones will heal after 4 weeks. After 1.5 months, the injured person becomes fully able to work.

Sometimes patients with a broken sternum need immediate surgery. The patient is sent to the surgical department if, after fixing the broken bones, the pain does not go away, and the person has problems in the functioning of the internal organs.

A person faces many dangers associated with increased injuries bone skeleton, chest injuries are also common. The realities of our world cause almost everyone to experience pain from various injuries.

Orthopedist-traumatologist: Azalia Solntseva ✓ Article checked by doctor

The lion's share of damage occurs in the long-suffering chest, which protects our most important organs - the lungs and heart - from damage.

Chest injuries occur as a result of accidents, falls from high altitude, causing wounds with sharp cutting objects. Modern society is following the path of degradation: constant mass fights, mass protests, street and gang fights, fights “behind the school.” All this leads to various injuries, bruises, and fractures.

In order to respond in a timely manner to emerging health threats, everyone must know the types of injuries, be able to distinguish between them, and know how to provide first emergency aid.

Varieties

Injuries are divided into two large groups: open and closed.

Closed injuries - occur as a result of accidents, can be caused by blunt objects, during the destruction of houses, massive structures.

Fractures of bones, ribs, damage to internal organs - all these are simple problems that do not require surgical intervention. Bone fragments can cause terrible damage to internal organs, mucous membranes, and the cardiovascular system.

Main types of closed injuries:

bruises,
fractures,
compression,
concussions.

Open injury - accompanied by profuse hemorrhage obtained by applying stabbing wounds sharp objects (knives, scalpels, sharp rods), firearms.

A person receives a chest wound, penetrating or non-penetrating.

This aspect is most important for a person non-penetrating wound does not pose such a danger, since the parietal pleura is not damaged.

Sharp pain in the chest area when trying to inhale;
Inability to palpate the affected area of the body (unbearable sharp pain);
At the site of injury, subcutaneous hemorrhages appear, which create swelling;
Loss of consciousness or respiratory arrest;
Relieving pain when sitting;
Trouble breathing when lying down;
Abdominal enlargement;
Presence of tachycardia;
Sudden drop in pressure.

You need to quickly contact a medical facility; delay can cost your life.

At emergency urgent care should be provided immediately medical care. To increase the effectiveness of first aid it is necessary to have basic knowledge about methods and types of assistance. It is much more important not to harm the injured person by using your knowledge in practice.

Video

Emergency first aid

An airtight bandage must be applied to the open wound to prevent air from entering the victim’s body;
Don't pull sharp object from the wound (if any);
As carefully as possible, transfer the sick person to a semi-sitting or sitting state;
Give painkillers.

The essence of providing first aid is to quickly transport the victim to a hospital or surgical department. At the same time, it is very important not to harm a person through careless actions.

The diagnostic examination begins when closed injuries chest, active work is carried out with open wounds Oh. Open damage accompanied by damage abdominal cavity of varying complexity. The surgeon is required to determine the severity of the injuries and decide on the need for surgical intervention.

For penetrating abdominal wounds, you should provide first aid, try to stop the bleeding, and wait for emergency services to arrive.

Features

IN medical institutions every doctor knows the main types and characteristic features of abdominal injuries, but we will now outline them:

Open abdominal injuries have an increased level of danger, since a feature of these injuries is the obligatory presence of piercing, cutting or laceration wounds.
Great loss of blood pain shock and rapid “fading” of the victim. The patient's condition can only be stabilized in clinics during surgical intervention. Objects that cause such a blow to the human body can be varied: bladed weapons and firearms, fragments of ammunition, household items.
Closed abdominal injuries pose no less a threat, which lurks in an imperceptible course destructive processes. The patient can end up in intensive care in an instant. Feature- damage or rupture of internal organs, which leads to hemorrhage and concentration of blood and its clots in the abdominal cavity.

Abdominal injuries can only be eliminated through surgical intervention, which affects the further process of recovery and rehabilitation.

According to statistics, injuries to the chest organs due to bruises occur in 15% of traumatic cases. The problem is dangerous because of its consequences, which can seriously harm human health. The chest protects vital organs (heart, lungs) from injury. Violation of their integrity can lead to death, so everyone should know how to provide first aid in such a case and where to turn.

What is a chest contusion?

IN medical terminology This concept is usually called mechanical damage soft tissues with a fast-acting, severe factor, accompanied by the formation of a hematoma. When a bruise occurs, a violation of integrity occurs chest wall, possible injuries to the heart, aorta, and lungs. These conditions can cause changes in the configuration of the sternum, rib fractures, which can lead to rupture of vital organs. Clinical manifestations chest injuries have pronounced local symptoms in the area of application of the traumatic force.

Reasons

The chest is damaged due to a strong blow. It can be called for the following reasons:

A car accident in which a person receives multiple injuries, including a bruised sternum.
Sports - blows plague athletes of many sports, but more often they are cyclists and representatives of contact martial arts.
A fall from a height or injury from an object falling on the chest - the degree of damage depends on the severity of the object and the height of the fall.
Domestic cases - chest injuries occur during a fight or impromptu street fighting.

Species

The classification of types of thoracic bruise consists of several elements. These include:

external and open injuries;
rib fractures;
vascular injury;
crushing of the sternum;
injury to the heart muscle;
dislocation, curvature of the capsular-ligamentous apparatus;
damage to nerve endings, spinal cord;
deformation of organs located next to the injury (abdominal wall trauma).

According to the degree of localization, contusion of the soft tissues of the chest can be of two types. These should include:

Contusion of the chest on the right - can cause damage to the lung, resulting in a risk of rupture of the organ with internal bleeding.
Left-sided contusion - in particularly difficult cases, can cause injury to the heart muscle, even leading to cardiac arrest with a fatal outcome.

Symptoms

Signs of chest injury depend on the severity of the injury and the time it was received. Symptoms are divided into general and local. The latter include:

Acute pain with pressure or sudden movements.
Swelling of the tissues at the site of the bruise due to the accumulation of lymph in them.
Constant pain syndrome characterized by aching, pulsating sensations when coughing or talking.
Hematoma formation due to injury small vessels, subsequent hemorrhage into soft tissues.

Symptoms of injury may increase. This happens when the lungs and pleura are damaged. The condition refers to common features complications of bruise. Symptoms:

slow heart rate;
demotion blood pressure;
temperature increase due to inflammatory process;
pale skin;
respiratory arrest;
hemothorax, pneumothorax, traumatic shock.

Diagnostics

The diagnosis is made by a surgeon or traumatologist. The standard procedure consists of the following methods:

Questioning the patient about his condition, time, and reasons for the injury.
Examination - to study the shape, size of the chest, the presence of deformation.
Palpation is carried out with careful movements to determine the condition of the ribs.
Radiography - study bone structures chest cavity.
MRI is a visual examination for damage to the chest organs, assessing the condition of soft tissues and blood vessels.
CT is prescribed after radiography to accurately diagnose bone structures.

First aid for chest contusion

IN emergency situation the victim requires first aid until the medical team arrives. The algorithm of actions is as follows:

The victim must be provided with complete rest; it is better to place him in a “half-sitting” position.
If a rib injury is suspected, apply a pressure bandage - ask the victim to inhale, then wrap tightly around his chest and secure the bandage to a healthy area of the body.
Apply an ice pack to the bruise to reduce swelling.
In case of severe pain, you can give the victim an analgesic local action(Kitanov, Baralgin).

Treatment

Methods and methods of therapy depend on the severity of the injury. The recommendations are as follows:

Mild bruise - treatment at home with restrictions motor function, the use of traditional and traditional medicine.
Average degree– the patient can be treated at home with general in good condition.If there is a suspicion of the development of complications, therapy is carried out on an outpatient basis.
Severe degree - immediate hospitalization to carry out life-saving measures.

Treating a bruise at home

For 2 days after injury, cold compresses should be applied to relieve swelling and pain. The procedure is carried out for 15-20 minutes 5 times a day. On the third day, the compresses should be warm, which promotes the resorption of the hematoma. Apply a tight bandage all the time after an injury - it will allow the treatment process to proceed more efficiently and reduce pain.

Such injuries disturb the victim's sleep. To prevent pain from interfering with sleep, attach the pressure bandage, a large pillow should be placed under the lower back. The mattress must be rigid, so the spine will not be deformed and the pain will become less pronounced. You should take a pain reliever at night. Exercise are limited, it is possible to do breathing exercises so that phlegm does not stagnate in the lungs. Magnetic therapy and electrophoresis procedures, which can be prescribed by a doctor, are useful.

Drug therapy

Treatment of chest contusion due to a fall, blow or accident is characterized by: an integrated approach. Effective use following forms and drug groups:

Painkillers (ointments, gels, tablets) – Baralgin, Tempalgin, Diclofenac, Spazmalgon.
Anti-inflammatory (tablets, ointments) – Ibuprofen, Nise.
Thrombolytic (ointments, gels) – Lyoton, Troxevasin. The drugs promote the resorption of the hematoma.

Drug treatment is often carried out using ointments. They can be classified as follows:

Ointments with non-steroidal components (Voltaren, Diklak) - eliminate external and internal inflammation.
Ointments based on badyagi (Comfrey, Larkspur) - resolve bruises and reduce pain.
Heparin ointments (Lavenum, Trombless gel) – relieve pain and have an antithrombic effect.

Gels and ointments for chest bruises are used more often than other remedies. For this reason, it is necessary to take a closer look effective drugs to treat a bruise. One of them is Finalgon:

Combined remedy for external use. It has a warming, vasodilating effect on bruises.
Recommended to apply small quantity ointments 2-3 times a day for 10 days.
The advantage of the product is its rapid action and wide range use.
Cons: many side effects, use only from 12 years of age.

Troxerutin-based gel, which strengthens blood vessels, is an antioxidant. The product has an anti-edematous, anti-inflammatory effect. It is used for pain and swelling after bruises, thrombophlebitis.
The gel is applied to the damaged area in the morning and evening for 6-7 days.
An undoubted advantage of the drug can be considered a small list side effects.
Disadvantage: cannot be used if the integrity of the skin is damaged.

For chest bruises, treatment is supplemented with systemic drugs. Example of Flogenzyme:

The tablets consist of animal enzymes and plant origin. They prevent the formation of edema, blood clots, inflammation, and have immunostimulating and analgesic properties.
The list of indications is huge. For bruises, take 3 tablets three times a day for 14 days.
The advantages of the drug lie in its systemic effect on the body.
The downside is the high cost of the tablets.

Heparin ointment is considered the most popular among people for bruises. Her description:

The drug belongs to the class of anticoagulants and painkillers. Relieves pain, inflammation, prevents the formation of blood clots.
The ointment is used for bruises and hemorrhoids. To speed up the resorption of the hematoma, a course of treatment is prescribed for 5 to 15 days. The product should be applied 2-3 times a day.
The main advantage of the ointment, in addition to the price, is its rapid absorption and speed of onset of action.
TO negative points refers to the condition of controlling blood clotting during prolonged use of the ointment.

The final product in the review is the Badyaga cooling gel. Its characteristics:

The gel is based on powder made from protozoa - river and lake sponges. The product accelerates the resorption of bruises, heals damaged vessels and capillaries, and relieves swelling.
The scope of application of Badyagi is huge, but for bruises the gel is prescribed 4 times a day until full recovery.
Advantages: low cost, the gel can be used even by newborns.
The drug has no disadvantages; individual intolerance to the components of the gel may occur.

Surgical intervention

Situations often arise that require resuscitation or surgical assistance in a hospital setting with subsequent rehabilitation. Such situations are possible in cases where complications arise after a bruise. These include:

hemothorax;
subcutaneous emphysema;
heart failure;
hematoma for more than 1 week;
thromboembolism;
pneumothorax.

If fluid, blood or air accumulates in the pleural cavity, the patient is given a drainage. It will help remove unnecessary components from the pleura. Then intensive care measures are carried out. If the hematoma lasts 7 days or more, the help of a surgeon is necessary. He makes a puncture in the damaged area, through which the stagnant blood comes out. Damage to the lungs, heart, large vessels requires immediate extensive surgery under general anesthesia.

Chest injuries

Chest injuries include injuries to the heart, lungs, or ribs. They can be blunt or penetrating. Blunt injuries commonly occur in car accidents and explosions, from the chest hitting a steering wheel, and during sports, such as collisions on a football field.

Blunt trauma and chest wounds are quite common. In order not to miss severe injuries to the chest organs, the examination must be complete, consistent and fairly rapid.

Treatment begins immediately in accordance with general principles resuscitation

(infusion therapy, airway management, stabilization

hemodynamics). Associated injuries, of which fractures are the most common,

head and abdominal injuries are often more dangerous than chest injuries. Therefore, treatment priorities should be determined from the very beginning.

Life-threatening conditions which occur with chest injuries and require

emergency care:

Cardiac tamponade due to bleeding into the pericardial cavity (wound, rupture or contusion of the heart, damage to the mouth of the great vessel).

Total hemothorax(damage to the heart or lung, rupture of a great vessel,

bleeding from intercostal vessels, abdominal trauma with damage to the diaphragm and bleeding into the pleural cavity).

Tension pneumothorax(lung rupture, extensive damage to the bronchi, “sucking” wound of the chest wall, damage to the trachea).

Aortic rupture or its large branch (blunt trauma - the result of sudden braking when the chest hits a stationary object, much less often - a penetrating chest wound).

Fenestrated rib fracture(or fracture of the ribs and sternum) with flotation of the chest wall (often accompanied by respiratory failure and hemothorax).

Diaphragm rupture(blunt trauma is often accompanied by extensive rupture of the diaphragm with

prolapse of abdominal organs into the chest cavity and breathing problems).

Penetrating wounds breasts are often accompanied by damage to the diaphragm and organs

abdominal cavity. Thoracoabdominal injury should be suspected if the wound is on

nipple level or below. Damage to the diaphragm and abdominal organs is also possible when

higher location of the entrance hole - if the wound is caused by a long object, and

also with gunshot wounds due to the unpredictability of the bullet's movement. At blunt trauma

the chest may be damaged by structures located at a considerable distance from the point of impact

(large vessel, bronchus, diaphragm). Even minor damage (for example,

isolated rib fracture). If you do not pay proper attention to them, serious

complications (including pneumonia).

Some types of injuries

Cardiac tamponade- acute heart failure caused by accumulation of blood or

other fluid in the pericardial cavity.

Pneumothorax- accumulation of air in the pleural cavity. The cause may be damage to the lung, trachea, bronchus, or chest wall, or a combination of these injuries. With “sucking” wounds of the chest wall, the pleural cavity communicates with the atmosphere; the disappearance of negative pressure in the pleural cavity makes breathing movements ineffective (open pneumothorax). If, during inhalation, air enters the pleural cavity, and during exhalation, the soft tissues of the chest wall or lung parenchyma block the wound channel and prevent air from escaping out, the pneumothorax is called valvular pneumothorax. In this case, the volume of air and pressure in the pleural cavity gradually increase and a tension pneumothorax occurs. The main pathophysiological consequences of open pneumothorax are hypoventilation and movement of air from a healthy lung to a collapsed lung during exhalation and back during inspiration. With tension pneumothorax, the veins of the mediastinum are also compressed, venous return is reduced and ventilation of the healthy lung is impaired. Myocardial dysfunction caused by oxygen starvation aggravates hemodynamic disorders.

Hemothorax- accumulation of blood in the pleural cavity. With hemothorax, vacuum in the pleural space

the cavity is preserved, so ventilation disturbances are significantly less than with pneumothorax. However, when heavy bleeding the blood compresses the lung and shifts the mediastinum to the opposite side. Total hemothorax is considered the most serious complication of chest trauma, since one pleural sac can contain more than half of the CBV. Particularly dangerous are puncture wounds at the base of the neck, which are often accompanied by damage to large vessels and bleeding into the pleural cavity. Drainage of the pleural cavity begins as early as possible; the sucked blood is used for reverse transfusion. If the drainage tube is not functioning satisfactorily and the hemothorax persists (clotted hemothorax), a thoracotomy is necessary to remove the blood clot to prevent the formation of fibrothorax or empyema. Sometimes this can be achieved by introducing fibrinolytic drugs into the pleural cavity.

Damage to the aorta and large vessels. In case of penetrating injury, the aorta may be

damaged anywhere. In blunt chest trauma, the aortic arch usually ruptures.

left subclavian artery at the level of the ligamentum arteriosus. (The most common mechanism of such

injuries - sharp braking when the chest hits a stationary object.) Ruptures of the ascending aorta and descending aorta at the aortic opening of the diaphragm are less common. When an aorta ruptures, most victims die at the scene. Among those hospitalized

Mortality in the first day reaches 50% if a diagnosis is not established and treatment is not carried out.

Rib fractures and other injuries to the chest wall lead to respiratory limitation

chest excursions, atelectasis, pneumonia. As a result, acute respiratory failure. The most dangerous are fenestrated fractures - multiple double or bilateral fractures of the ribs with the formation of a “rib valve”. However, even an isolated rib fracture can lead to severe breathing problems.

Damage to the lung parenchyma(rupture, wound) often occur with rib fractures, penetrating chest wounds and as a complication of CPR. Damage to the pulmonary veins can be complicated by air embolism of the vessels of the systemic circulation, so a clamp is immediately applied to the root of the lung, and then the damaged vessel is ligated or sutured.

Lung contusion characteristic of blunt chest trauma and is often localized under the “costal

valve." Acute respiratory failure may develop within 24-48 hours after injury.

The clinical picture and radiographic findings of a lung contusion resemble pneumonia, however

At first there is no fever or signs of infection. Diffuse blood permeation of the parenchyma

lungs, caused by multiple hemorrhages, can lead to exclusion from

ventilation of the affected area of the lung, intrapulmonary shunting of blood and hypoxemia. These changes develop gradually and reach a maximum 24-48 hours after injury, so the diagnosis is often made late.

Ruptures and injuries of the trachea and bronchi usually lead to pneumomediastinum, pneumothorax, and release of large amounts of air through the drains. X-rays reveal atelectasis, sometimes separation of the lung from the root. In case of incomplete rupture of the main bronchus, the defect may be closed by sealed tissues, and there will be no clinical picture. In this case, after a few weeks or months, granulation tissue develops at the site of damage, the lumen of the bronchus narrows and the lung completely collapses. Typical localization of damage is the carina of the trachea in case of blunt chest trauma, the border of the larynx and trachea in case of a blow to the neck. Concomitant pulmonary artery injury is common.

Acute mediastinitis - This is a rapidly occurring, very severe infectious process with high mortality. Most often it is caused by perforation of the esophagus, less often by rupture of the trachea or infection from the oropharynx. The main symptoms are pain behind the lower parts of the sternum or between the shoulder blades, dysphagia, respiratory distress and crepitus with blooming sepsis, unstable hemodynamics, which progresses rapidly. Fluid and antibiotic therapy should be started immediately. The main factor is eliminated in accordance with the fundamental principles. Drainage of the mediastinum through the tissues of the chest and neck is required.

Chylothorax- accumulation of lymph in the pleural cavity. Chylothorax occurs when

damage to the thoracic lymphatic duct (cervical or thoracic). It's pretty rare

a complication of chest injuries, occurs mainly with penetrating wounds of the mediastinum.

Characteristic signs - increasing accumulation of fluid in the pleural cavity, separation

milky white liquid through the drains. In most cases, thoracic lymphatic duct defects close on their own. Until recovery, the “nothing inside” rule applies;

Diaphragm rupture usually occurs with blunt trauma to the chest or abdomen. Penetrating

wounds to the chest and abdomen may also be accompanied by damage to the diaphragm, which, when

conservative treatment often remains unrecognized and manifests itself many years later

strangulated diaphragmatic hernia. Moreover, a wound to the diaphragm is often not noticed even during

time of laparotomy. In contrast, blunt trauma typically results in extensive rupture of the diaphragm, often with prolapse of the abdominal organs into the thoracic cavity (that is, the formation of a traumatic diaphragmatic hernia). Chest x-rays typically show horizontal levels of fluid and gas in the lower lung fields. Large traumatic hernias make breathing difficult.

Heart damage. In case of injuries, the anterior right ventricle and the anterior interventricular branch of the left coronary artery are most often affected. The heart wound is sutured with non-absorbable sutures, placing sutures over the entire thickness of the myocardium and taking care not to involve the coronary arteries. In case of damage to the proximal parts coronary arteries The only way to avoid extensive myocardial infarction and death of the patient is emergency coronary bypass surgery. Only the most distal branches can be ligated. With penetrating wounds of the heart, damage to intracardiac structures is possible; therefore, during the operation, all chambers of the heart are carefully palpated. Trembling during palpation is a sign of disruption of the integrity of the interventricular septum or valve. Ventricular septal defects in the acute period after injury, as a rule, are not sutured. The same goes for valve damage. With blunt chest trauma, ruptures of the heart chambers with the development of tamponade are possible. Most of these patients die at the scene; the rest require emergency surgical intervention. During surgery, as a rule, an atrial rupture is discovered that needs to be repaired. Cardiac contusion is treated in the same way as myocardial infarction, since clinical picture, and complications (including arrhythmias, ventricular wall rupture) are very similar. In severe cases, inotropes and intra-aortic balloon counterpulsation may be required.

Traumatic asphyxia occurs with strong immediate or prolonged compression

chest. The face, neck and upper half of the chest (“neckline”) are bluish or purple

coloring, the color of the rest of the skin is not changed. Peculiar hemorrhages in the skin, mucous membranes, and under the conjunctiva are also characteristic. IN acute period neurological symptoms are noted

(loss of consciousness, mental disorders, epileptic seizures), which usually disappears in

within 24 hours after the injury. Facial cyanosis cannot be immediately regarded as a sign of respiratory

failure and begin mechanical ventilation.

I . Inspection

1. Cyanosis is a sign of increasing hypoxemia caused by respiratory failure.

If only the face, neck and upper half of the chest (“neckline”) are bluish, you need

suspect traumatic asphyxia that occurs when the chest is compressed. For

traumatic asphyxia is also characterized by pinpoint hemorrhages in the skin, mucous membranes, under

conjunctiva.

2. Spontaneous breathing - presence or absence ;

retraction of the intercostal spaces during inspiration ( respiratory failure, airway obstruction);

paradoxical breathing (fenestrated rib fracture with flotation of the chest wall);

unilateral respiratory movements (bronchus rupture, pneumothorax, unilateral hemothorax); stridor (damage to the upper respiratory tract).

3. Soft tissue swelling , especially the eyelids and neck (subcutaneous emphysema) - a sign of damage

lung or main bronchus.

4. Pay attention to unusual breathing sounds, stridor, and “sucking” wounds of the chest wall.

5. For penetrating wounds, be sure to inspect both the anterior and posterior surfaces.

torso (an exit hole may be located on the back).

II. Subcutaneous tissue . The neck, chest, arms and abdomen are quickly palpated. Subcutaneous emphysema is a sign of tension pneumothorax or bronchial rupture.

III . Rib cage . The ribs and sternum are sequentially palpated, and the chest is lightly compressed in different directions. Pay attention to the symmetry of the chest, the nature of the respiratory movements, and a section of the chest wall moving in an unnatural direction (“costal valve”). With a rib fracture

IV. Cervical veins. Swollen, non-pulsating jugular veins are a sign of cardiac tamponade. In addition, swelling of the jugular veins is observed

V . Lungs. When auscultating the lungs, breath sounds in the right and left lungs are compared. If they differ, perform percussion. Dullness to percussion on the affected side means either hemothorax or atelectasis (blockage of the bronchus by mucus plug, aspiration

foreign body). A loud tympanic (box) sound over one lung, especially when

a penetrating wound on this side is a sign of pneumothorax. Possibly tense

pneumothorax.

VI. Heart murmurs may indicate damage to one of the valves (which is often found with blunt chest trauma), rupture of the papillary muscles or the interventricular septum. If a noise resembling crunching snow (pericardial friction rub) is heard during diastole, there may be air in the pericardial cavity.

Principles of treatment.

After resuscitation and staging

preliminary diagnosis determines treatment tactics. There are three options - drainage

pleural cavity, surgery and expectant conservative therapy.

Indications for drainage of the pleural cavity:

Pneumothorax (any degree)

"Sucking" wound of the chest wall

Acute hemothorax (any degree).

Subacute hemothorax (moderate or total)

Indications for surgery:

Cardiac tamponade

Extensive gaping wound of the chest wall