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Chest injuries - types, symptoms, treatment. Closed chest injury

– injuries in which the bones that form the frame are damaged chest and/or organs located in the chest cavity. This is a large and quite diverse group. traumatic injuries, including both rib fractures and vital injuries important organs(lungs and heart). Often, injuries to the chest pose an immediate threat or potential danger to the patient's life. Often accompanied by blood loss of varying severity and the development of acute respiratory failure, which can develop both immediately and some time after the injury. Therefore, without exception, all patients with chest injuries should be urgently referred to a specialized medical facility. an institution for examination and further treatment, which, depending on the type of injury, can be either conservative or surgical.

ICD-10

S20-S29

General information

Chest injuries are a group of injuries that include injuries to the ribs, sternum and internal organs located in the chest cavity. Such injuries can vary greatly in both nature and severity, but due to potential danger for the patient's life initial stage are always considered by doctors as serious, requiring a detailed examination of the patient. This group of injuries is characterized by high mortality in the absence of medical care and sufficient high percentage favorable outcomes with timely delivery of the patient to a specialized medical facility. institution. The mortality rate is 5-6%, with the majority of deaths occurring due to open injuries (wounds), as well as multiple rib fractures with lung rupture.

Classification

All chest injuries are divided into two groups: closed and open. Distinctive feature closed damage is the absence of a wound. Such damage is divided into:

  • Concussions. Injuries in which visible morphological changes the chest is missing.
  • Bruises. This group includes bruises of the ribs and soft tissues, bruises of the heart, bruises of blood vessels, bruises and ruptures of the lungs, hemothorax and pneumothorax, fractures of the sternum, ribs and thoracic vertebrae.
  • Compression. This includes cases of traumatic asphyxia, in which the patient's chest is compressed between two blunt objects, causing suffocation.

With open injuries in the chest area there is a wound, which can be a knife wound, a gunshot wound, etc. Open injuries (wounds) are divided into:

  • Non-penetrating.
  • Penetrating.
  • Without damage to internal organs located in the chest cavity.
  • With damage to internal organs located in the chest cavity.
  • With bone damage (ribs, thoracic vertebrae or sternum).
  • Without open pneumothorax or with its presence.
  • Without open hemothorax or with its presence.
  • Thoracoabdominal trauma (with simultaneous violation of the integrity of the chest cavity, diaphragm and abdominal cavity).

Taking into account the nature of the damage, through, blind and tangential chest wounds are also distinguished.

Reasons

In peacetime, closed chest trauma occurs in traumatology much more often than open one. Its main causes are car accidents (70%), falls from a height (23%), work-related injuries, natural disasters, criminal acts (beating, fighting) or domestic trauma. Most often, with closed trauma, injuries to the lungs (60%), ribs (45.4%), heart (8%) and spine (4.8%) are detected. Other organs are rarely affected. Damage to the lungs, intercostal vessels, pleura, bronchi and pulmonary vessels more often it is secondary in nature and develops as a result of traumatization of these organs by the sharp ends of broken ribs.

Open injuries are rare in peacetime and usually result from wounds with edged weapons. The number of gunshot wounds increases sharply in wartime. Wounds caused by another object (for example, a sharp metal pin or piece of reinforcement) can occur as a result of a work-related injury, a man-made or natural disaster, or a domestic accident.

Fractures of ribs and sternum

Rib fractures usually occur in adult patients. Very rare in children and adolescents due to extreme elasticity bone structures. Taking into account the mechanism of injury, all rib fractures can be divided into three groups: indirect, direct and avulsion. The greatest displacement of fragments and, as a consequence, a high probability of damage to the organs of the thoracic cavity from the sharp ends of broken ribs occurs with avulsions, double and multiple fractures.

Fragments of the ribs can damage not only the lung and pleura, but also the intercostal vessels, resulting in internal bleeding in the pleural cavity and hemothorax is formed. If the sharp end of the rib punctures the lung, air escapes into the pleural cavity and a pneumothorax is formed.

A rib fracture is indicated by sharp pain at the site of injury and pain when the chest is compressed in the anteroposterior direction. Breathing becomes shallow. It is easier for the patient to be in a sitting position than in a supine position. Main method instrumental diagnostics is a radiography of the ribs. Treatment consists of eliminating pain, preventing pneumonia and making breathing easier.

For an uncomplicated fracture of one rib, the patient is on outpatient observation. A fracture of two or more ribs is an indication for hospitalization. Patients are prescribed analgesics and physiotherapy, and are recommended to remain in bed in a semi-sitting position. For warning stagnation in the lungs, breathing exercises are necessarily prescribed. In case of multiple rib fractures, they are surgically immobilized.

Fractures of the sternum are relatively rare. Accompanied by pain, aggravated by coughing and deep breathing. Palpation is sharply painful. To confirm the diagnosis, a lateral x-ray of the sternum is performed. Treatment is carried out in a hospital setting. For non-displaced fractures, rest and painkillers are prescribed. When displaced, reposition is performed on the shield.

Bruises, concussions and compression

These chest injuries are less common than rib fractures and are caused by blunt force trauma or forced compression between two large blunt objects. A chest contusion is accompanied by a small hematoma and moderate pain. Usually not required special treatment. IN in some cases at severe bruise may arise extensive hemorrhage in the tissue or cavity of the chest, sometimes accompanied by rupture of organs and tissues. Such an injury is classified as severe, requires emergency hospitalization and can result in the death of the patient.

When the chest is concussed, extremely severe shock occurs in the absence of anatomical changes. The patient's condition is serious, breathing is uneven, painful, and shallow. The pulse is rapid, uneven, barely perceptible. Extremities are cold, cyanotic. Required immediate hospitalization, complete rest and inhalation of oxygen under pressure.

With chest compression breathing movements are violated. Blood flows from the shoulders, upper chest, neck and head. Choking develops. Possible disturbances of consciousness. The skin of the listed parts of the body turns blue, and numerous small hemorrhages (ecchymoses) form on it, as well as on the conjunctiva and oral mucosa. A symptom of décolleté is revealed - swelling and cyanosis of the upper body. Possible temporary loss of vision and hearing due to hemorrhages and optic nerve, retina, eyeball and inner ear.

The patient is hospitalized and recommended to remain at rest in a semi-sitting position. To eliminate pain, novocaine vagosympathetic blockades are performed. Carrying out sanitation respiratory tract, oxygen therapy and, in some cases, artificial ventilation lungs.

Open damage

With non-penetrating chest injuries, the condition of the patients is satisfactory. Treatment consists of applying a bandage or suturing the wound. With penetrating wounds, the condition of patients can vary significantly and depends on the absence or presence of hemopneumothorax and concomitant damage to the internal organs and bone frame.

Hemothorax in such injuries develops due to bleeding into the pleural cavity from damaged vessels of the lung and chest wall, pneumothorax - due to the penetration of air from the wounded lung into the pleural cavity. When the lung is injured, hemoptysis, hemothorax and subcutaneous emphysema are observed. To clarify the diagnosis, a chest x-ray is performed. Treatment is surgical. Patients are hospitalized in a specialized department, where thoracic surgeons urgently perform surgery and suturing the wound. The extent of intervention depends on the nature of the injury.

Hemothorax

Hemothorax (accumulation of blood in the pleural cavity) is formed when bleeding due to damage to the intercostal vessels, lung or internal mammary artery. There are small (less than 500 ml), medium (from 500 to 1000 ml) and large (more than 1000 ml) hemothorax. If the condition is low, the patient does not suffer or suffers only slightly. Maybe conservative treatment. With average hemothorax, the patient's condition moderately or slightly worsens, breathing becomes more frequent. Both conservative treatment and pleural puncture may be required.

With large hemothorax, shock, hemodynamic disturbances, shrinkage of the lung and displacement of the mediastinal organs are observed. The patient's skin is cyanotic, the pulse is rapid, and breathing is also rapid and shallow. The body position is forced, sitting, supported by hands. Required pleural puncture, or, if the hemothorax increases, a thoracotomy to identify and eliminate the source of bleeding. All patients with hemothorax in mandatory are hospitalized. Observation includes repeated fluoroscopic or X-ray studies to assess dynamics and determine further tactics treatment.

Pneumothorax

Pneumothorax is an accumulation of air penetrating into the pleural cavity from a damaged lung or from the external environment. There are three types of pneumothorax: closed, open and valvular. With a closed pneumothorax, the wound is closed with soft tissue. The amount of air is limited and does not increase. A small amount of air resolves on its own; moderate amounts may require pleural puncture.

Open pneumothorax occurs with chest injuries. His hallmark is the presence of communication between the pleural cavity and the external environment. During inhalation, air penetrates through the wound, and during exhalation, it leaves it. The lung gradually collapses. It is necessary to close the wound and puncture or drainage of the pleural cavity. With increasing (valvular) pneumothorax, air enters the pleural cavity, but then does not leave it. The patient's condition is rapidly deteriorating. There is increasing respiratory distress, shortness of breath, suffocation, tachycardia, cyanosis of the mucous membranes and skin. Immediate drainage of the pleural cavity is required.

In addition to compression of the lung on the side of the injury, pneumothorax causes mediastinal voting - a pendulum-like movement of organs during inhalation and exhalation. The heart and blood vessels are displaced, and blood flow to the heart decreases. This further aggravates the patient's condition. All patients are hospitalized. Accepted emergency measures to eliminate pneumothorax. Subsequently, it is carried out dynamic observation, repeated fluoroscopy of the lungs or x-rays are performed.

Chest injuries account for about 10% of all peacetime injuries. Depending on the mechanism of injury, the nature and intensity of the force of the acting factor, various injuries may occur.

There are closed (when the integrity of the skin is not broken) and open injuries (wounds) of the chest, and there are open ones that do not penetrate into the chest cavity (when the integrity of the parietal pleura is preserved), and those that penetrate into the pleural cavity.

Closed and open injuries can be with or without fracture of the ribs or sternum, without damage and with damage to the chest organs.

With all types of chest trauma, the depth and rhythm of breathing and normal coughing are disrupted, which leads to hypoxia and possible complications.

Closeddamage occur as a result of a blow, concussion or compression of the chest. The nature and severity of injuries depend on the mechanism and intensity of the injury.

Chest contusion

More common are ordinary chest bruises, which are sometimes accompanied. When the soft tissues of the chest are struck, local swelling and pain appear, and sometimes a subcutaneous fluctuating hematoma (with a tangential blow). Due to hemorrhages in the muscles, the patient breathes shallowly, and taking a deep breath increases the pain. To clarify the diagnosis, be sure to percussion and auscultation examine the condition of the lungs and take an x-ray of the injured half of the chest.

Treatmentsick consists of prescribing painkillers (analgesics, novocaine blockade), puncture of the hematoma, and after 3-4 days - thermal procedures, breathing exercises. Sometimes blood from a hematoma that has not resolved is removed through a skin incision. Antibiotics are not prescribed to prevent complications. Performance is restored in 2-3 weeks.

Chest concussion

A mild concussion may not be clinically apparent. The patient only feels a change in the depth and rhythm of breathing, lack of air. Severe concussions of the chest are accompanied by hemorrhage into the lungs and resemble the condition severe shock. The general condition of the patient is serious; cyanosis, cold and wet extremities, rapid, arrhythmic pulse, rapid, shallow and uneven breathing. Severe concussions sometimes result in the death of the patient. Such patients require intensive care, sometimes resuscitation, and then symptomatic therapy.

Rib fractures

Single rib fractures, as a rule, occur as a result of direct trauma - at the point of application of force (impact, pressing against a certain object). Double rib fractures occur. When the chest is compressed in the anteroposterior direction, several ribs break along the axillary line, and in the lateral direction, along the paravertebral and midclavicular lines. Multiple bilateral rib fractures occur in severe road traffic injuries, rubble, etc. Sometimes a sharp fragment of a rib can damage intercostal vessels, perforate the parietal pleura and even injure the lung.

Symptoms. The patient complains about sharp pain at the fracture site, increases at the height of inspiration. The general condition of the patient depends on the severity of the injury (number of damaged ribs, degree of lung failure, blood loss, pleuropulmonary shock, etc.).

With single rib fractures, the patient's general condition remains satisfactory. The patient spares the chest and breathes shallowly. Due to the pain, he cannot cough up the mucus that accumulates in the upper respiratory tract, and therefore gurgling appears, and over time, pneumonia can develop. Hemoptysis indicates lung damage.

During palpation, the points of maximum pain are determined. If you squeeze the chest lightly, local pain increases, and the patient points to the fracture site. With double fractures of the ribs (fenestrated fracture), when inhaling, this area sinks, and when exhaling, it levels out. Such flotation of the chest wall with each breath is very painful, which affects the nature of breathing, the function of the organs of the mediastinum, which also floats, and the general condition of the patient.

Multiple and especially bilateral rib fractures cause severe respiratory distress, hypoxia and traumatic pleuropulmonary shock. The examination of the patient includes chest x-ray, percussion and auscultation to identify rib fractures and possible complications - pneumothorax, etc.

Treatment for uncomplicated rib fractures

If individual ribs are damaged, treatment is limited to pain relief, improvement of breathing conditions and prevention of pneumonia.

The patient is placed in a semi-sitting position in bed. A local or paravertebral blockade is performed with a 1% novocaine solution, and analgesics are prescribed. After anesthesia, chest excursion improves, and breathing becomes smooth and deep, the patient can even cough up sputum, which prevents the occurrence of pneumonia. The blockade is repeated 2-3 times. In addition, patients are prescribed breathing exercises And symptomatic therapy. Fractured ribs heal in 3-4 weeks, performance is restored in 5-6 weeks.

For multiple rib fractures (four or more), complex treatment, which is determined by the severity of the patient’s condition. In order not to disturb a seriously ill patient with repeated blockades and to maintain constant pain relief, a thin tube (vascular catheter) is inserted into the paravertebral area through a needle, which is left, glued with an adhesive plaster to the chest wall, and its second end (catheter cannula) is brought out to the shoulder girdle. When pain occurs, without moving the patient, 15-20 ml of a 0.5% novocaine solution is injected into the catheter (4-5 times a day).

Patients with severe breathing disorders are also treated with cervical vagosympathetic blockade according to A.V. Vishnevsky and undergo intensive therapy, and sometimes resuscitation measures (, mechanical breathing, etc.).

In case of double fenestrated rib fractures, to eliminate flotation, under local anesthesia fix the ribs with Kirschner wires passed percutaneously, or apply them to the sinking area of ​​extraction (stitching behind soft fabrics and periosteum of the middle rib with a coarse mylar thread or using bullet forceps). Ribs fixed using the following methods fuse in normal time. Open osteosynthesis of ribs is used extremely rarely.

Complextreatment also includes oxygen therapy, suction of mucus from the trachea, antibiotic therapy, etc.

Complications of rib fractures

Rib fractures, especially multiple ones, are often complicated by hemothorax, closed and valve pneumothorax, and subcutaneous emphysema.

Hemothorax

Hemothorax called 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, it does not reach the level of the lower angle of the scapula (300-500 ml). Total hemothorax (1-1.5 l) is extremely rare.

Levelhemothorax determined by percussion and radiological vertical position the patient sitting. 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 suck the blood out.

Symptoms. Small hemothorax does not have special signs, and 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 surgery to stop the bleeding. But before that, a puncture and 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, after hemothorax, it develops exudative pleurisy. 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. V.).

The elastic lung tissue contracts, and the lung collapses - a closed lung 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 during hemothorax the chest is punctured in lower section, then with pneumothorax - 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” may stick, and a regular closed pneumothorax will form. In these cases, air is sucked out from the pleural cavity 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 drained according to 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 suture. The finger is dipped into a sterile jar filled with aqueous solution 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 subcutaneous emphysema: swelling in the area of ​​air accumulation, and upon palpation - a specific crunch in subcutaneous tissue(“snow walking”) due to the bursting 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.

Sternum fractures

They usually occur as a result of direct trauma. Most often, a fracture occurs at the junction of the manubrium and the body of the sternum, less often - the xiphoid process and the body of the sternum. The displacement of the fragments is insignificant.

Symptoms. The patient complains of local pain, which intensifies during deep inspiration and coughing. By palpation, local fluidity and the degree of displacement of fragments are determined.

The diagnosis is clarified by radiography in the lateral projection of the sternum.

Treatment. 10 ml of 1% novocaine solution is injected into the fracture area. For fractures without displacement of fragments special treatment not required. The sternum grows together in 3-4 weeks. If there is a backward displacement of the body of the sternum, the patient is placed on a bed with a shield and a cushion is placed under the thoracolumbar region to achieve sufficient reclination. After comparison of the fragments, reclination can be reduced.

After 3-4 weeks the patient is discharged. Average term incapacity for work 6 weeks.

Surgical treatment for sternal fractures is indicated only when pain or dysfunction of the mediastinal organs remains after reposition.

Often, injuries and various types of injuries to the thoracic region mean fractured ribs; in addition, the most important organs of the human body (heart, lungs, main blood vessels) are injured. When providing first aid to the victim, do not forget to determine whether there are breathing problems that are extremely dangerous to human life. This is the consequence that is most typical for the type of injury under consideration.

Consequences

There are several most dangerous consequences chest injuries:

  • Pneumothorax (accumulation in the pleural cavity large quantity air).
  • Hemothorax (blood entering the pleural cavity).
  • Emphysema of the mediastinum (begins to put pressure on large veins).
  • Traumatic suffocation.
  • Heart bruise.
  • Cardiac tamponade (accumulation of blood in the pericardium as a result of its damage by rib fragments).

Types of injury

Types of damage:

  • thoracic injuries (injuries can be open or closed);
  • lung damage;
  • injuries that are more complex (this may be rupture of the bronchi or diaphragm, dysfunction of the heart muscle).

These types of chest wounds can be inflicted with a knife or other weapon. Knife wounds often occur during fights and various domestic quarrels; puncture wounds can also occur due to negligence and during road accidents, emergencies and various natural and man-made disasters.

Injuries received by a person from firearms mainly occur during military operations, demonstrations, pickets, as well as during fights, shootings and quarrels. These injuries can be inflicted to the human body a bullet, an automatic or machine gun burst, a fragment or shot. And also during the explosion of mines, grenades and the use of explosive cluster shells.

Depending on the weapon used, they are divided into through, blind and tangential wounds. The first wounds have two holes - into which the damaging object entered, and a second hole from which this object came out. The second type of wound has only an entrance hole and no exit hole.

Characteristics of wounds

Injuries to the chest can be inflicted tangentially, then only soft tissue is damaged. A penetrating injury may break the bones of the chest, disrupt the area around the lungs, and damage the lungs. As a result of a wound inflicted by a knife, the integrity of the soft tissues is mainly destroyed and blood vessels are damaged, while the bones remain intact. If a wound is received after the use of any type of weapon, not only soft tissues and blood vessels are destroyed, but bones are broken, and the broken bones, under the force of the shot, are subsequently broken and torn internal organs and chest bones.

Knife wounds

Wounds inflicted by sharp piercing and cutting objects are accompanied by the following damage to organs, soft tissues and blood vessels. In many cases, a penetrating injury causes damage to the lungs, causing air to enter or bleeding to occur.

The cause of bleeding can be ruptured internal intercostal and other arteries that are located in the chest. As a result of this bleeding, a person's respiratory function and heart function deteriorate. In the case where air has entered the lungs, but there is no bleeding, all necessary medical methods must be taken. After a few days, the air will be able to leave the lungs.

Wound in the heart area

In addition to soft tissues, arteries and blood vessels, the injury can affect both the lining of the heart and the organ itself. very serious as it can lead to stopping of this body, as a result of which the person dies.

Basically, as a result of injury to an organ such as the heart, the atrium or ventricles are damaged, in in rare cases Only the lining of the organ is damaged. The wound is very dangerous due to the bleeding in the form of a fountain, and the blood fills nearby organs.

Gunshot wounds

At gunshot wound chest injuries are more serious, as they entail rupture of tissues, tendons, bones, blood vessels and arteries. In addition to the charging substance itself, which gets into the wound, pieces of clothing and other foreign objects are also involved in it. With such a wound, in addition to organs located in the chest, organs located in the chest may also be damaged. abdominal region human body.

The location of the wound depends on the type of weapon used, the angle and distance from which the shot is fired. If the shot is fired from above, the bullet can enter the stomach through the respiratory tract. Depending on the power and caliber of bullets or shells, the liver, kidneys and other internal organs may also be damaged in the body.

Since breathing is impaired, the person feels unwell due to lack of oxygen in the blood. In addition, there is pain and irregular heartbeat. Blood emerges from the wound, as if filled with oxygen, in the form of foam. This means that the lungs are damaged, and the wounded person may also have blood in his saliva. Or bleeding from oral cavity and at the same time from the wound. In case of a heart injury, a person has a changed complexion and sweating increases on the body. People with this type of injury are in shock and are often admitted to the hospital unconscious. When checking your pulse, the result is barely noticeable. In the case of a bullet wound, blood pressure is greatly reduced.

Visually, if the heart is damaged, you can see an enlarged area on the chest in the area of ​​the heart. If during a shot a bullet hits the liver, blood vessels or spleen, blood from these organs fills all the empty space and all organs inside the abdominal part of the body.

Symptoms

The chest, despite its rigid structure, is more often susceptible to trauma than any other area bone skeleton. Careless fall, sudden blow, illness or emergency are quite capable of disrupting the integrity of the costal arch and sternum, leading to multiple problems with the respiratory and cardiovascular systems.

In order to diagnose the onset of serious failures, you need to know the symptoms of damage to the walls of the sternum:

  1. Pain syndrome, which occurs every time deep breath or exhale.
  2. The cough is chesty and very strong, with a whistling sound.
  3. Hemorrhage. If there is internal bleeding and inflammation of the internal organs, the cough is quickly supplemented by sputum mixed with blood.
  4. Deformation of the bone corset. If there was a fracture of the vaults.
  5. The development of pneumothorax - that is, excessive accumulation of air in the pleural cavity. Its signs are gurgling, whistling, hoarse tones when inhaling or exhaling. Main danger This condition is the development of acute respiratory failure, asphyxia, atony.
  6. Increase in body temperature to 38-39 degrees.
  7. Fever.
  8. Pulmonary edema. Manifested by the appearance of white foam near the mouth in combination with a violation respiratory function, rapid heartbeat, decrease or sharp increase blood pressure, dizziness, weakness, nausea.

First aid

It turns out that she is both in place and urgently in the near future. medical institution. First aid for a penetrating chest injury should be provided on the spot; if this is not done, medical care will already be useless. This is the case when it does not enter the body required quantity oxygen. You urgently need to apply a cotton or gauze swab to the wound site, lubricating it with something greasy so that air does not get into the wound. Then you need to put a piece of polyethylene and a bandage on top.

For any type of injury, the patient must be urgently taken to the nearest medical facility.

Saving a life

First aid for a penetrating chest injury is to give the patient pain medication, as such injuries are quite painful. You can use metamizole sodium, ketorolac, tramadol in a dosage of 1-2 ml. And only medical workers in exceptional cases they can give the victim narcotic analgesic, for example a 1% solution of promedol. You also need to find something to treat the open wound with (hydrogen peroxide, iodine, brilliant green).

When a rib is fractured, the first thing to do is to apply a fixative, airtight bandage. If there are wounds, they must be treated, then cellophane is applied to the damaged area and only after that a fixing bandage is applied.

For heart contusion accompanied by chest pain, low blood pressure and rapid heartbeat, apply medical supplies blocking pain. As a rule, they are administered intravenously. Transportation of victims is possible only in a supine position with the upper body slightly elevated on a stretcher. In case of cardiac tamponade, transportation is carried out in a semi-sitting position using a stretcher. Without exception, all victims with chest injuries need urgent medical intervention. To do this, the patient is taken to the nearest surgical department, where doctors stop the bleeding and also use pain-relieving drugs and drugs to support heart function. Additionally, oxygen inhalations are used.

In case of cardiac tamponade, it is necessary to perform a pericardial puncture. Blood begins to flow continuously from the needle that pierced the pericardium. It is not removed until the patient is taken to the hospital, where doctors completely stop the bleeding. Also, during development, the doctor pierces the pleural cavity with a needle, after which he removes the air and blood accumulated there.

How to transport with a chest injury?

Transportation of the victim should be carried out, observing certain rules regarding the position in which he is located. Therefore, the attendant must exercise special attention to the position in which the wounded is transported. Help should be given to bring him into a semi-sitting position with his knees bent. Having brought the victim into this position, it is necessary to place a cushion under him. Transportation must also be carried out in accordance with the following principles:

  • efficiency;
  • safety - it is necessary to ensure the patency of the victim’s airways, ensure gas exchange, as well as access to the respiratory tract;
  • gentle attitude - it is not allowed to cause pain to a wounded person by failing to comply with transportation conditions, as this can lead to a state of shock.

The likelihood of saving the life of a wounded person directly depends on the success of the transportation, in particular, on the position occupied. Thus, compliance with the principles of transportation is one of the most important points in delivering to the chest area.

Treatment

Necessary primary medical care is to find something to treat the open wound, apply a bandage with a thick layer of sterile cotton wool, covered with a bandage, the edges should be several centimeters larger than the diameter of the injury. Stopping the flow of air into the tissues using a special patch will also help.

Before transporting the wounded, painkillers should be administered:

  • morphine;
  • pantopon, etc.

For bullet wounds, shattered parts or severe bruises should be removed surgically. This will help prevent sepsis and further tissue decay.

Treatment of bruises

In case of severe contusion of the chest, the patient must be provided with free access to oxygen, introduce an anesthetic blockade. Regardless of the type of chest injury, an x-ray is required to fully understand the extent of the damage.

Only after this is it appointed further treatment and a decision is made as to whether it is necessary surgery. With a mechanical concussion of the chest, the victim experiences state of shock and problems with independent breathing appear. In this case, it is necessary to organize the flow of air artificially.

Treatment of open wounds

In case of receiving open, lacerated injuries, it is necessary to stop the bleeding. Also, with injuries of this nature, it is impossible to do without suturing. If a rib is fractured, the victim’s movements should be limited until the ambulance arrives, as the bone may touch the heart, blood vessels or lungs, which will lead to more serious injury. serious consequences, for example, to hemorrhage. At the hospital, the ribs will be fixed in correct position using a special corset. X-rays should not be neglected, as they can help identify the presence of fragments that need to be removed surgically. During the healing process (from 4 to 7 weeks), painkillers are used, for example, Novocain.

If the lungs are injured, the first step is to apply a tight bandage while exhaling. The victim should not be allowed to lose consciousness from loss of blood, as this can even lead to fatal outcome. Next, the wounded person requires artificial respiration and measures to treat soft tissues. antiseptics to prevent infection and suturing. Later, when the lungs are injured, regular dressings are first necessary to avoid the appearance of purulent wounds.

When providing first aid, acute, life-threatening respiratory failure is often observed. As a rule, they are characteristic of chest injuries. The classification of chest injuries is extremely simple:

  • Closed and open chest injuries.
  • Lung damage.
  • Complex injuries (damage to the heart muscle, rupture of the diaphragm, bronchi, trachea, etc.).

Chest injuries are associated not only with damage to the ribs or sternum, but also to such important organs as the heart, lungs, bronchi, trachea, esophagus, pleura, diaphragm, as well as blood vessels. Often after a chest injury, pneumothorax also appears. Air penetrates into the pleural cavity, under the influence of which the organs located in it are compressed and displaced. Pressure or displacement of organs can occur due to the accumulation of blood in the pleural cavity. Often the victim experiences shock. As a result of respiratory failure, oxygen deficiency develops, which leads to disruption of the functioning of many organs. Injuries to the thoracic cavity are life-threatening: the mortality rate is up to 25%.

However, the first aid provider is not able to immediately determine the type of damage. Therefore, when providing first aid, it is always recommended to behave as if both the lungs and the chest were damaged. Following the same principle, measures to provide first aid to the victim are selected.

Symptoms

  • Dyspnea.
  • Cough.
  • Side pain.

In cases of trauma to the chest, and especially when the lungs are also damaged, symptoms of shock occur due to impaired gas exchange. The victim is pale, his skin is cold and damp. Drops of sweat appear on the nose and neck, the arterial pulse is rapid, gradually weakening. Another important symptom is shortness of breath. In addition, a whistling sound comes from the wound.

When a rib is fractured, only the chest wall is usually damaged, the lungs remain unharmed. However, if blood accumulates in the pleural cavity or air enters through the damaged area, then the lungs cannot function normally - breathing and gas exchange are disrupted. When several ribs are fractured, breathing problems can also occur, which may also impair the stability of the chest itself. The breathing disorder that occurs in this case is called “paradoxical breathing,” since when inhaling, the victim’s chest does not expand, but narrows.

Causes of injury

Depending on the nature of the injury, chest injuries may vary. Blunt injuries occur from a bruise, blow, or fall. They most often occur during accidents, accidents, or sports. Open injuries to the chest area are less common; the causes of such injuries are gunshot or knife wounds. Damage to chest organs may occur due to explosion or inhalation toxic fumes and gas.

Lung injuries

In this case, only the lung (one or both) is damaged. Such damage may be caused by a sudden increase in pressure (for example, due to an explosion) or illness (for example, pulmonary tuberculosis). If damaged lung tissue sputum contains blood.

Chest and lung injuries

This type of complex injury is the most common. It may arise as a result mechanical impact(for example, gunshot or puncture wound). The integrity of the chest wall is compromised, lung tissue ruptures, and severe internal bleeding begins.

In older people, spontaneous rib fractures are possible, e.g. severe cough. In this case, you should also consult a doctor, since quite often such fractures can be a symptom of a more serious disease.

Injuries often occur in road accidents

In the past, when wearing a seat belt was not mandatory, chest injuries were much more common than they are now. These injuries would be even less common if drivers always wore their seat belts, since hitting the steering wheel with your upper body can cause severe chest and abdominal injuries.

First aid for chest injury

First of all, the victim must be laid on his back, it is advisable that he leans on his hands - this makes it easier for him to breathe.

  • Do everything to make breathing easier for the victim - unfasten clothes, loosen belts and other items of clothing that make breathing difficult.
  • If the wound is open, it must be covered with a sterile, breathable bandage. Calm the victim. Talk to him, try to persuade him (despite his fear) to breathe calmly.
  • Make sure that the victim is not cold. Cover it with a blanket if necessary.
  • Chest injuries (especially if the lungs are also damaged) are classified as serious injuries, so call an ambulance as soon as possible.
  • The victim’s body should not be given a “penknife” pose (i.e., lay the patient horizontally, raising his legs).
  • The victim should be given a semi-sitting position, or can be laid on his side. However, if the victim wants to sit or lie in some other position, then you can help him take the desired position.

Treatment of chest injuries

The choice of treatment method depends on the nature and severity of the injury. There is usually no treatment for rib fractures. The patient is prescribed only painkillers. However, with very severe pain and difficulty breathing, the patient is given artificial ventilation. If several ribs are fractured, surgery is performed to immobilize them.

Minor lung injuries accompanied by minor bleeding most often heal successfully. However, if a large amount of blood collects in the pleural cavity, then drainage with blood suction is necessary. For heart contusions, stimulant medications are prescribed. Severe damage to the heart muscle leads to cardiac arrest. Sometimes restoring the activity of the heart and saving a person’s life can only be emergency surgery. If there is a threat of tamponade, an emergency puncture is necessary. The operation is also indicated for rupture of the diaphragm, bronchi, trachea and esophagus. If the patient is in shock, he must be treated.

For minor chest injuries, such as bruised ribs, apply a cold compress to the injured area.

If breathing becomes impaired as a result of a blow to the chest or a fall, you should immediately consult a doctor.

First of all, the doctor will evaluate the victim’s breathing, heart activity and blood circulation. In emergency cases, for example, with pneumothorax or hemothorax, the doctor performs drainage of the pleural cavity; if the airway is obstructed, intubation is performed (a plastic tube is inserted into the larynx to facilitate breathing). After the necessary resuscitation actions done x-ray. It is necessary to monitor blood pressure, breathing, urination, do regular testing gas composition patient's blood, record an electrocardiogram.

Some chest injuries, such as broken ribs, are harmless and heal without complications. However, serious injuries to the chest can lead to the death of the victim. Injuries involving heart damage are especially dangerous. Excessive blood loss can lead to serious complications, such as embolism and infection.

The chest not only contains vital organs and protects them from the harsh influences of the external environment, but is also an active organ, damage to which leads to disruption of the function of external respiration.

Chest injuries. Classification

If we classify chest injuries, it is necessary to distinguish between closed (blunt injuries) and open injuries (for example, wounds).

Closed chest injury

You can get a closed chest injury during road accidents, falling from a height, and also if you are injured with a blunt object, as is often described in a criminal situation. Closed chest trauma often occurs in the rubble of destroyed houses or underground communications of mines, less often in sports.

The severity of damage to internal organs is of decisive importance for clarifying the diagnosis, choosing treatment tactics and prognosis. Among closed-type chest injuries without violating the integrity of internal organs, a distinction is made between chest injuries when bones are damaged (meaning the chest and ribs, because spinal fractures are an independent nosological category) and without bone damage.

Closed chest injuries without fractures of the ribs or sternum, as well as injuries to internal organs, are considered minor injuries that do not require special treatment. Sometimes there are still victims with large subcutaneous and intermuscular hemorrhages, which causes serious condition patient even without fractures or injuries of intrathoracic organs.

Closed chest injuries accompanied by rib fractures can cause catastrophic consequences regardless of whether internal organs are damaged:

  • firstly, multiple, and especially bilateral rib fractures, lead to a gross disruption of the mechanism pulmonary respiration, resulting in severe hypoxia;
  • secondly, with rib fractures (even in the case of a fracture of only one rib), rupture of the intercostal artery and parietal pleura may occur, followed by the development of massive hemothorax and accumulation of more than 1.5 liters of blood in the pleural cavity.

Blunt chest injuries accompanied by damage to internal organs (lungs, heart, trachea, bronchi and great vessels) are considered severe regardless of the condition of the bone frame of the chest.

According to the classification, there are closed chest injuries with damage to internal organs, accompanied or not accompanied by fractures of the ribs or sternum. Both may be complicated by pneumothorax and/or hemothorax. It may also be that there will be no hemorrhage and/or air will not accumulate in the pleural cavity. Pneumothorax can occur due to rupture of the trachea, lung, or even bronchus during a sharp increase in intrathoracic pressure immediately at the time of injury. And at the moment of fracture - due to damage lung tissue and visceral pleura with sharp ends of bone fragments.

Massive hemothorax in blunt trauma is caused by bleeding from ruptures of the lung, main blood vessels and heart, and intercostal vessels. Pneumothorax and hemothorax, regardless of the genesis and source of air and blood entering the pleural cavity, greatly complicate the condition of the victim, which worsens the prognosis.

Open chest injury

Required component open injury chest wall is a wound of the chest wall. Such a wound can be inflicted with cold and firearms, fragments of devices that have exploded, sharp and blunt objects, as well as hard objects. Chest injuries can occur in wartime, as well as in peacetime, in everyday life and in criminal situations, during mass injuries and accidents. If the chest wound does not penetrate deeper than the pectoral fascia and the parietal pleura remains intact, then the wound is non-penetrating. If the parietal pleura is damaged, the wound is regarded as penetrating. Penetrating and non-penetrating wounds can be blind or through. This grouping is especially important for characterizing spherical, fractional and shrapnel wounds, because when a blind wound occurs (as opposed to a through wound), the object that wounds remains inside the victim, and the surgeon must weigh all the indications and contraindications for its removal.

First aid for chest injury

Based on the large number of types of chest injuries, it is quite difficult to immediately determine the nature and severity of the injuries, which causes problems when providing first aid for chest injuries. Because it is difficult to immediately tell exactly what has been damaged, you should pay close attention to the signs and symptoms of damage and act on the assumption of the worst.

  1. If a rib is broken, it is necessary to give the victim pain medication, since such injuries are very painful. After this, you need to apply a tight fixing circular bandage. In case of air penetration into the pleural cavity (pneumothorax), it is necessary to make a sealed bandage (apply a layer of polyethylene to the wound, and then bandage the damaged area). When transporting a casualty, the patient should sit and not lie down. If there are complex fractures, the patient is hospitalized.
  2. Squeezing, concussions and bruises are less severe chest injuries, although they are no less painful. First, you need to eliminate the pain with painkillers, then quickly call an ambulance. If pneumothorax is observed, apply an insulating bandage, then urgently take the patient to the hospital. In this case, surgical intervention is necessary.

Transportation of victims with chest trauma should be carried out by specialists.

Consequences of chest injuries and complications of chest injuries

Chest injuries may be accompanied by damage to internal organs. At first glance, the possibility of injury to internal organs when a non-penetrating injury occurs may seem paradoxical. However, this happens if the object that wounds does not penetrate the pleural cavity, but at the time of injury causes a concussion of the chest, sharp increase intrathoracic pressure and rupture of internal organs, most often the lungs. This insidious option causes diagnostic errors, because the surgeon, having convinced himself of the non-penetrating nature of the wound, excludes damage to internal organs. The antipode of damage to internal organs during non-penetrating wound is the so-called lucky through wound, when the internal organs remain unharmed.

The presence or absence of pneumothorax, hemothorax, emphysema and mediastinal hematoma, and pericardial tamponade is of decisive importance in assessing the severity of the condition, treatment tactics and prognosis. These complications occur during various injuries breasts They cause severe, sometimes catastrophic, breathing and circulatory disorders. The organization of first aid and the treatment program depend on understanding the essence of the pathophysiological disorders that occur during complications.