Chest trauma

Chest trauma accounts for about 10% of all injuries in peacetime. It often leads to very serious complications in the respiratory and cardiovascular systems.

Chest injuries are usually divided into two types:

1. closed chest injuries without damage and with damage to internal organs;
2. wounds that penetrate and do not penetrate the chest cavity.

Closed chest injuries vary in nature and severity of damage. These include bruises, chest compression, rib and sternum fractures.

Chest contusion

It is caused by direct trauma in road traffic accidents, as well as domestic and sports injuries.

In case of chest contusions, hemorrhages into the subcutaneous tissue and intercostal muscles may occur at the site of injury, which is manifested by local swelling and is accompanied by pain. The pain intensifies when palpating the site of the hemorrhage, as well as during inhalation and exhalation. The pain gradually decreases over the course of about a week and then disappears without a trace.

When providing first aid, it is recommended to apply cold (ice pack) and spray the bruise with ethyl chloride in the first hours to reduce bruising and pain. Prescribe painkillers: analgin or acetylsalicylic acid. To quickly absorb the blood that has spilled into the soft tissues, use heating pads, semi-alcoholic warming compresses and physiotherapy procedures (UHF, novocaine electrophoresis, etc.).

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Chest compression

It is a more severe type of injury and occurs when two opposing forces act on the chest (compression between two solid bodies). These injuries can be observed in avalanches, in train conductors, and when performing agricultural work.

When the chest is compressed, the air in the lung is compressed, which often leads to rupture of the lung tissue, blood vessels and bronchi. When the chest is compressed, the pressure in the veins of the neck and head increases, small vessels rupture and pinpoint hemorrhages appear on the mucous membranes of the larynx, in the conjunctiva, skin of the face and on the upper part of the body. With severe compression of the chest, traumatic asphyxia develops as a result of a sudden increase in intrathoracic pressure.

Clinically, chest compression is manifested by shortness of breath, increased heart rate, bluish discoloration of the skin of the face and neck with the presence of pinpoint hemorrhages on the skin of the head, neck, and upper chest.

Sometimes, in severe cases, serous sputum may appear when coughing.

After the victim has been pulled out from under the rubble, it is necessary to provide him with urgent first aid. The victim experiences constant severe pain and shortness of breath. He needs to be kept at rest, given painkillers (morphine solutions, omnopon, promedol intramuscularly). If respiratory failure increases, oxygen inhalation is indicated. In the ambulance, inhalation of a mixture of oxygen and nitrous oxide is carried out to relieve pain and improve ventilation.

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Rib and sternum fractures

They occur as a result of direct trauma of great force.

A distinction is made between uncomplicated and complicated rib fractures. In uncomplicated rib fractures, the pleura and lung are not damaged. In complicated rib fractures, damage to the intercostal vessels, pleura, and lung tissue occurs.

In uncomplicated rib fractures, unlike chest contusion, the pain syndrome is sharply expressed during chest movements during inhalation, exhalation, as well as during coughing and sneezing; a lag of the damaged half of the chest is noted during breathing. In case of multiple rib fractures, breathing is shallow, up to 20-22 per 1 min. A fracture is differentiated from a contusion by an increase in pain at the fracture site during a counter load on the undamaged parts of the chest. This test can be carried out only if the condition of the victims is satisfactory to decide on the choice of the place of their treatment.

Clinical diagnosis of rib fractures is not always confirmed by X-ray. In these cases, the diagnosis is made only on the basis of clinical data. First aid for rib fractures should be aimed at creating rest by providing a comfortable position. In case of uncomplicated rib fractures, external immobilization is not necessary, it will only make breathing difficult and can lead to pneumonia. The victim can be given analgin, amidopyrine (pyramidone) and other painkillers orally.

In case of uncomplicated rib fractures, working capacity is restored on average within 3-5 weeks.

Isolated fractures of the sternum usually occur as a result of a direct blow or pressure on the sternum in the anteroposterior direction. A fracture of the sternum is accompanied by sharp pain, which intensifies with inhalation and palpation, and difficulty breathing. The most typical is the anteroposterior displacement of fragments, which is determined in the first minutes during palpation. Subsequently, a large subcutaneous hematoma forms and the fragments cannot be palpated. If a sternum fracture is suspected, the victim is placed on a stretcher with a shield in a supine position. Before transportation, it is advisable to give the victim analgesics and cardiac drugs (sublingual validol) due to the risk of contusion of the mediastinal organs.

Complicated rib fractures are possible with more severe injuries, when a rib fragment, shifting inward, damages the intercostal vessels, pleura, and lung tissue.

Normally, the pressure in the pleural cavity is lower than atmospheric pressure. This promotes normal blood circulation: it facilitates the flow of blood to the heart, as well as the straightening of lung tissue even with shallow breathing.

Clinical diagnosis of complicated rib fractures consists of general and local signs.

Common signs include the patient's forced position: he tries to sit up and reduce the excursion of the injured half of the chest. In addition to pain at the fracture site, there is a feeling of shortness of breath. The skin is usually pale, the mucous membranes are cyanotic. The number of breaths exceeds 22-24 per minute, breathing is shallow. The victims have hemoptysis - an admixture of blood in the sputum from streaks to a solid bloody clot. The pulse reaches 100-110 per minute. With careful palpation, it is possible to determine the "crunch of snow" - subcutaneous emphysema on the side of the fracture. The presence of subcutaneous emphysema should be alarming: as a rule, subcutaneous emphysema indicates the presence of a closed pneumothorax.