Approximately 10 percent of people with domestic chest injuries enter traumatology. At the same time, various injuries to the body can be detected in the victims, it all depends on the mechanism of injury, its nature, as well as the intensity of the force exerted on the human chest.
Bruises and injuries of the chest are closed and open. If the integrity of the skin is not broken, then the damage to the sternum is called closed. If the patient received a chest wound with an open wound, such an injury is called open. The latter, in turn, is divided into a wound that does not penetrate into the chest cavity (the integrity of the perital pleura is preserved in the victim), as well as a penetrating one, that is, a penetrating wound into the pleural cavity was found in the injured person.
Closed and open chest injuries can be with or without bone fractures. There may also be damage to the internal organs behind the chest.
With any of the listed types of injuries, the depth and rhythm of breathing is disturbed in a person, the victim cannot cough normally, which, in turn,leads to hypoxia.
Closed blunt chest injuries can result from impact, compression, or concussion. The nature and scale of damage depend on the intensity of the injury and the mechanism of action on the affected area.
Chest bruises
Most often, traumatologists are faced with closed chest injuries with bone fractures. If a person received a blow to the soft tissue of the chest, then a local swelling forms on the damaged area, the patient complains of pain, and a subcutaneous fluctuating hematoma forms on the body. As a result of hemorrhage in the muscles, the victim can only breathe superficially, because a deep breath greatly increases pain. To make an accurate diagnosis, medical professionals need to examine the lungs using fluorography.
As a first aid for a chest injury, a person is prescribed painkillers (most often novocaine blockade). Also, the patient needs to undergo a series of thermal procedures, and after a few days, do breathing exercises.
In the event that the blood accumulated in the hematoma area does not resolve, the surgeon will need to make an incision in the skin. A person becomes able-bodied after about 21 days of treatment.
Chest concussion
Minor concussion resulting from chest injuries (ICD-10 codes them S20-S29) can do without consequences. The patient only briefly, after physical contact, will feel a lack ofair, as well as impaired breathing. After some time, the body recovers and returns to its normal rhythm of life.
Severe concussions are characterized by hemorrhage into the internal organs, accompanied by a slight shock. The patient's condition after the injury is extremely severe, he has cold extremities, rapid pulse and breathing. Sometimes these injuries are fatal. To save a person, you need to resort to intensive care as soon as possible. If necessary, immediate resuscitation should be carried out, after which medical workers should resort to symptomatic treatment.
Bone fractures
Rib fractures are most often due to direct trauma to the chest. This can be a strong pressure with a massive object or a sharp blow. In medical practice, there are also double fractures. If the chest is compressed in the anteroposterior direction, then several ribs located in the axillary line may break at once. When exposed to the chest from the side, the bones of the paravertebral line are injured.
Bilateral rib fractures are most common after a major car accident or during a natural disaster, such as an earthquake, when victims are trapped under rubble. Such injuries are often exacerbated 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 broken ribs
Victims who have received a chest injury usually complain of a sharp and strongpain at the site of injury. At the same time, pain sensations increase many times 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 broken rib, then his general condition is satisfactory. A person cannot inhale a large amount of air due to pain, is unable to cough up, release mucus from the lungs, as a result of which it accumulates in the upper respiratory tract. If the person does not receive medical attention soon, they may be at risk of developing pneumonia. Also a symptom of a bone fracture in the sternum is hemoptysis.
To help with a chest injury and broken ribs, you need to find the points where the person feels the most pain. To find the fracture site, you should find the place where the chest is easily compressed when pressed, and the pain increases significantly. This is the site of injury to the bones.
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 on exhalation, on the contrary, levels out. In this case, the victim feels severe pain, he is not able to take a strong breath. This condition negatively affects the nature of breathing, the work of internal organs in the body is disrupted.
Multiple rib fractures, especially bilateral,cause severe respiratory failure, hypoxia, and pleuropulmonary shock. In order to make an accurate diagnosis, to correctly fix the body to fix the fracture, to perform an operation to extract bone fragments, the patient must be sent for an x-ray, percussion. In the absence of qualified assistance, the patient can quickly develop numerous complications, such as pneumothorax or hemothorax.
Treatment of simple fractures
If only one rib is broken as a result of a chest injury, and the victim has no complications, then the attending physician prescribes painkillers. Measures must also be taken to improve breathing conditions. The patient must take drugs that serve to prevent pneumonia.
The patient in the hospital is moved to the bed in a semi-sitting position. To alleviate suffering, the patient is given a local blockade with a Novocain solution, and analgesics are also used. After the painkillers have taken effect, chest excursion improves significantly, breathing becomes even and deeper. The patient is able to cough. The blockade should be repeated several times.
After several days of rest, the patient is sent for therapeutic exercises, as well as symptomatic therapy.
Thanks to modern methods of treatment, the ribs of an injured patient grow together within a month. Full recovery of the body occurs 2-3 months after the injury.
Treatment of multiple fractures
In case of fractures of four or more ribs, doctors carry out complex treatment, which is carried out depending on the severity of the injury. To ensure the immobility of the patient, a thin vascular catheter is inserted into the paravertebral region, 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 shoulder girdle area. If the victim feels acute pain, then about 20 ml of anesthetic is injected through the catheter (usually this is a Novocain solution). Depending on the severity of the injury, a drug that helps a person to relax is used up to 5 times a day.
If a patient has a respiratory disorder due to a severe injury to the chest organs, then in this case, doctors apply a vagosympathetic blockade according to Vishnevsky A. V., and also carry out intensive therapy. Sometimes resuscitation is required, namely intubation and machine breathing.
If a person has double fractures of the ribs during the study 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 of knitting needles is fixed on the recessed section of the sternum. Securely fixed ribs fuse within a few months.
For the complex treatment of the victim, oxygen therapy is used, antibiotics are prescribed, and, if necessary, mucus is sucked out of the trachea.
Possible Complications
MultipleFractures in the chest area are often accompanied by complications, such as valvular pneumothorax, hemothorax, and subcutaneous emphysema.
What is a 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 abundance of bleeding:
- Total, which is extremely rare. With this disease, up to 1.5 liters of blood is released.
- In an average hemothorax, blood is formed in the region 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 an x-ray or percussion.
Symptoms of hemothorax
A small accumulation of blood is quite difficult to detect, because there are no special signs in this disease. During a visual examination of the patient, only signs of a fracture of the ribs are clearly visible on the 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 an average hemothorax, one of the lungs is compressed, which leads to hypoxia, severe shortness of breath, sometimes the patient has a hemodynamic disorder. Often the patient's body temperature rises to39 degrees.
Treatments
Hemothorax is one of the complications resulting from rib fractures, so the patient is prescribed complex treatment. With a small accumulation of blood, it resolves on its own over time, however, a puncture is still done to minimize the amount of blood near the affected area.
If there is a significant amount of stagnant blood, then 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, the patient will have to be operated on.
If after all the procedures the blood accumulates again, then the diagnosis is "bleeding from a damaged vessel". In this case, a person admitted to a medical facility is punctured, and then a Ruvelua-Gregoire test is performed to determine how fresh the stagnant blood is. Next, the patient is transferred to the operating table for a thoracotomy (opening the chest).
Sternal fracture
This injury usually occurs after a direct injury. Most often, a bone fracture occurs in the place where the handle passes into the body of the sternum, sometimes the bones crack in the place of the xiphoid process. With an injury in this place, the displacement of bone fragments is insignificant.
Stern injury symptoms
The victim complains of pain in the chest area, which greatly increases with inspiration. Also, the patient feels acute pain when coughing. To make a diagnosis, it is necessary to determine the place by palpationfracture, and also to find out if there are small pieces of bone. An x-ray is also taken in the lateral projection of the chest.
How to treat
In the place where the fracture is found, the doctor injects 10 ml of Novocaine solution. If the identified fracture is without displacement, small fragments of bones are absent in the human body, then special treatment is not required. The bones will grow back in a month. If the displacement of a part of the chest after an injury is found, then the patient should be placed on a bed with a shield. A special medical roller must be placed under the thoracolumbar region in order for the injured bones to return to their original position.
If the diagnosis is made correctly, and the patient was given qualified assistance, then the bones will grow together after 4 weeks. After 1.5 months, the affected person becomes fully able-bodied.
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 anywhere, while the person has disorders in the work of the internal organs.
