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Trauma of the chest
Last reviewed: 20.11.2021
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Trauma of the chest in peacetime is about 10% of all injuries. It often leads to very serious complications from the respiratory and cardiovascular systems.
Trauma of the chest is divided into two types:
- closed chest injuries without damage and with damage to the internal organs;
- injuries that penetrate and do not penetrate into the chest cavity.
Closed chest injuries are varied in nature and severity of damage. These include bruising, chest compression, fractures of the ribs and sternum.
Chest bruise
It is caused by direct injuries in road accidents, as well as in domestic and sports injuries.
With bruises of the chest at the site of injury, hemorrhages may occur in the subcutaneous tissue and intercostal muscles, which is manifested by local swelling and is accompanied by painful sensations. The pain increases with a feeling of the place of hemorrhage, as well as during inspiration and exhalation. Painful sensations about a week gradually decrease, and then completely pass.
When providing the first pre-medical care, it is recommended to apply cold (ice-bladder) and spraying the site of the injury with chloroethyl in the first hours to reduce bruising and pain. Assign painkillers: analgin or acetylsalicylic acid. For the fastest resolution of the blood flowing into the soft tissue, warmers, half-alcohol warming compresses and physiotherapeutic procedures (UHF, Novocain electrophoresis, etc.) are used.
Chest compression
It is a more severe type of injury and occurs when two opposing forces are applied to the chest (compression between two solid bodies). These damages can be observed at landslides, at train-keepers, at performance of agricultural works.
At the time of compression of the chest, compression of air located in the lung occurs, which often leads to rupture of lung tissue, blood vessels and bronchi. At the time of compression, the pressure in the veins of the neck and head rises, small vessels burst and point bleeds appear on the mucous membranes of the larynx, in the conjunctiva, the skin of the face and on the upper part of the trunk. With severe compression of the chest as a result of a sudden increase in intrathoracic pressure, traumatic asphyxia develops.
Clinically, compression of the chest is manifested by shortness of breath, rapidity of the pulse, cyanotic staining of the skin of the face and neck with the presence of pinpoint hemorrhages on the skin of the head, neck, upper sections of the thorax.
Sometimes, in severe cases, the appearance of serous sputum can be observed when coughing.
After extracting the victim from the dam, it is necessary to provide him with urgent first-aid first aid. The victim experiences constant severe pain, dyspnea. He needs to create peace, introduce painkillers (solutions of morphine, omopon, promedol intramuscularly). With increasing respiratory insufficiency, oxygen inhalation is indicated. In the ambulance car, inhalation is carried out with a mixture of oxygen and nitrous oxide in order to relieve pain and improve ventilation of the lungs.
[7], [8], [9], [10], [11], [12], [13], [14], [15], [16]
Fractures of ribs and sternum
Occur when exposed to direct injury of great force.
There are uncomplicated and complicated fractures of the ribs. In uncomplicated fractures of the ribs, the pleura and lung are not damaged. With complicated fractures of the ribs, there is damage to the intercostal vessels, pleura and lung tissue.
In uncomplicated fractures of the ribs, in contrast to the bruise of the chest, the pain syndrome is sharply expressed when the chest moves with inhalation, exhalation, and also with coughing and sneezing; there is a lag in the damaged half of the thorax during breathing. With multiple fractures of the ribs, the respiration is shallow, up to 20-22 per 1 min. Differentiate the fracture from a bruise to increase pain at the site of the fracture with a counter load on the undamaged thoracic segments. This test can be carried out only with satisfactory condition of the victims to decide the choice of the place of their treatment.
Clinical diagnosis of fracture of the ribs is not always confirmed radiologically. In these cases. The diagnosis is made only on the basis of clinical data. The first pre-medical care for rib fractures should be aimed at creating peace by giving a comfortable position. With uncomplicated fractures of the ribs, external immobilization is not needed, it only hinders breathing, can lead to pneumonia. The victim can be given inside analgin, amidopirin (pyramidone) and other painkillers.
In uncomplicated fractures of the ribs, the work capacity is restored on average 3-5 weeks.
Isolated fractures of the sternum arise, as a rule, due to a direct stroke or pressure on the sternum in the anteroposterior direction. A fracture of the sternum is accompanied by a sharp pain, which increases with inhalation and palpation, with difficulty in breathing. The most characteristic is the anteroposterior displacement of fragments, which is determined in the first minutes upon palpation. Subsequently, a large subcutaneous hematoma is formed and the fragments can not be probed. If suspected of a sternum fracture, the victim is placed on a stretcher with a shield in the position on the back. Before transportation, it is advisable to give the patient analgesics and cardiac agents (validol under the tongue) in view of the danger of injury to the mediastinal organs.
Complicated fractures of the ribs are possible with more severe injuries, when a fragment of the rib, displacing to the inside, damages the intercostal vessels, pleura, lung tissue.
Normally, the pressure in the pleural cavity is below atmospheric pressure. It promotes normal blood circulation: it facilitates the flow of blood to the heart, as well as the spreading of lung tissue even with shallow breathing.
Clinical diagnosis of complicated fractures of the ribs consists of general and local signs.
Common signs are the forced position of the patient: he tries to sit down and reduce the excursion of the damaged half of the chest. In addition to pain in the place of fracture, there is a feeling of lack of air. The skin is usually pale, the mucous membranes are cyanotic. The number of breaths exceeds 22-24 per minute, breathing is superficial. The victims are hemoptysis - an admixture of blood in the sputum from veins to a continuous bloody clot. Pulse reaches 100-110 per minute. With careful palpation, you can identify "snow crunching" - subcutaneous emphysema on the side of the fracture. The presence of subcutaneous emphysema should alert: as a rule, subcutaneous emphysema indicates the presence of closed pneumothorax.