In the world there are a large number of diseases that many people are not even aware of. But there are cases when it is simply necessary to know about the symptoms of acute human conditions in order to be able to immediately provide first aid to the patient. But it is not always possible to determine a disease or serious pathology visually, in this case, modern diagnostic methods, for example, such as the Ruvilua-Gregoire test, will come to the rescue. But what can be determined thanks to this test, and what kind of analysis is it?
Sample Ruvilua-Gregoire: what is it?
This test is one of the diagnostic methods that allows you to very quickly determine if there is intrapleural bleeding or not with hemothorax. A positive test of Ruvilua-Gregoire indicates that the bleeding inside the pleura continues, and a negative test indicates that it stops, or it is, but not so active.
But what is hemothorax, how to treat it, what are the consequences in case of inaction in this condition of the patient?
Hemothorax: what is it?
Hemothorax is bleeding that occurs inside the pleura and leads to the fact that a large amount of blood accumulates in it, which is ultimately accompanied by compression of the lung. The Ruvilua-Gregoire test allows you to quickly determine the presence of bleeding and its intensity. In addition to diagnosis, it is possible to recognize blood loss by the following symptoms:
- chest pain;
- low pressure;
- dizziness;
- pale skin and others.
If the patient has such manifestations, then he must be urgently taken to the hospital in order to diagnose and take all measures to stop the bleeding. But what can trigger hemothorax?
Causes of pathology
Diagnosis of hemothorax may be needed for those patients who have received a chest injury, have a number of pathologies or iatrogenic causes of bleeding.
By injuries, doctors mean injuries to the chest of various kinds. Hemothorax can develop as a result of an accident, a gunshot wound, fracture of the ribs, a fall from a great height and other reasons.
Such injuries can lead to damage not only to the lungs, but also to other organs:
- heart
- liver
- spleen;
- apertures;
- intercostal vessels;
- thoracic artery;
- lungs.
Hemothorax can also cause diseases of the patient, such as:
- aortic aneurysm;
- tuberculosis;
- malignancy in the lungs or pleura;
- lung abscess
- hemorrhagic diathesis;
- coagulopathy and others.
Iatrogenic factors leading to hemothorax (the Ruvilua-Gregoire test will help determine its presence) are complications after surgery on the lung or pleura, drainage of the pleura, and the installation of a catheter in the central veins.
The pathogenesis of hemothorax
The accumulation of blood in the pleura can cause compression of the lung and displacement of the internal organs, and this leads to the fact that the respiratory surface of the lung is significantly reduced, respiratory and hemodynamic disorders occur. For this reason, hemothorax often develops a clinical picture of hemorrhagic and cardio-pulmonary shock, which leads to the fact that the heart and respiratory organs are not working properly.
In the first hours after the blood got into the pleura, the inflammatory process develops in the last. With hemothorax, the Ruvilua-Gregoire test will help to determine it (edema appears, leukocyte infiltration, mesothelial cells swell and desquamate). At first, the blood that entered the pleura through bleeding is no different from peripheral blood, and a little later, the level of hemoglobin, the index of red blood cells and white blood cells decreases.
When it enters the pleura, the blood coagulates, but after a short period of time, the process of fibrinolysis begins, due to which it liquefies again. Anticoagulant factors contribute to this process. There are several classes of hemothorax. What are their differences?
Hemothorax Classes
We have already said that hemothorax can be traumatic, pathological and iatrogenic. In addition, taking into account the power of bleeding, it is also divided into several classes:
- small - blood accumulation occurs in the sinus, and the volume of blood loss is not more than 500 ml;
- medium - blood has already dropped to level 4 ribs, and its volume is about one and a half liters;
- subtotal - blood dropped to the lower level of 2 ribs, and the volume of blood loss is about two liters;
- total - on the x-ray, blackout is noticeable from the side of the pleura lesion, and blood loss is more than the spirit of liters.
In addition, hemothorax, determined by the Ruvilua-Gregoire test and other diagnostic methods, can be apical, interlobar, paracostal, supraphrenic, paramediastinal, it all depends on the location. Also, if bleeding continues, hemothorax is called increasing, and if it has stopped, it is called stable. If not only blood but also air enters the pleura at the same time, in this case we are talking about hemopneumothorax. But what symptoms may indicate hemothorax?
Signs of hemothorax
The clinical picture directly depends on the intensity of bleeding, compression of lung tissue and organ displacement. Small hemothorax may not be accompanied by symptoms, mainly the patient complains of chest pain, which may intensify during coughing, and shortness of breath may also appear.
But the middle and large classes, which can be confirmed using the Ruvilua-Gregoire test, are accompanied by respiratory disorders, cardiovascular disorders and others. It is simply impossible to ignore the symptoms to such an extent, because severe pain may appear, which intensifies with coughing, weakness in the whole body, and blood pressure decreases. With a little physical exertion, all symptoms worsen. The patient chooses a comfortable position for himself - sitting or half-sitting.
But with severe hemothorax, a weakness appears that does not even allow you to rise, your head is spinning, tachycardia develops, the skin turns pale, flies flash before your eyes, fainting often occurs. But not always symptoms can accurately indicate hemothorax, so it is best to consult a doctor who will prescribe a number of studies, including the Ruvilua-Gregoire test. With hemothorax , this is the best method that will quickly indicate the presence or absence of bleeding.
Diagnostics
During an accurate diagnosis, the doctor specifies all the details of the disease, physical and other examination methods are prescribed, including laboratory ones. With hemothorax, it should immediately be determined whether there is a lag in the affected side during respiratory movements, whether the percussion sound dulls over where the fluid has collected, whether breathing is weakened, or if there is a trembling voice.
An X-ray of the lungs reveals collapse of the lung, the presence of fluid (the patient is in a horizontal position during the study) or clots in the pleura. In order to diagnose and clarify the diagnosis, pleural puncture for hemothorax can be prescribed, in this case, the receipt of blood confirms the diagnosis. To recognize sterile and infected hemothorax, samples of Petrov and Efendiev are made, which make it possible to assess the transparency and sediment of the aspirate.
A laboratory blood test will determine the number of white blood cells and red blood cells. Other diagnostic methods, such as ultrasound, X-ray, chest CT, diagnostic thoracoscopy, can also be performed.
What allows you to determine the sample?
To confirm that the bleeding is continuing or that it has already stopped, it is simply necessary to conduct a study such as the Ruvilua-Gregoire test. A diagnostic technique of this kind involves the collection of blood from the pleura, after which they look at it. If it coagulates in a test tube or syringe, then this means that bleeding continues, and if there is no coagulation, then no. Next, the samples are sent to the laboratory for further research, and they already determine the amount of hemoglobin.
A positive test of Ruvilua-Gregoire is an indicator of emergency thoracotomy, which will help stop bleeding. This diagnostic method is informative, but still it is better to additionally conduct other examinations in order to be 100% sure of the diagnosis. But how to make a test?
Hemothorax puncture technique
Only a qualified doctor should conduct the test, because this study is very complex, and if the blood sampling is incorrect, then the patient can be harmed even more. Puncture with hemothorax is a unique diagnostic technique, which is carried out between 6 and 7 ribs in the mid- and posterior axillary line. At this point, the patient should be in a sitting position. Blood is sent for examination, a solution of an antibacterial drug is administered.
Conservative Therapies
Conservative treatment helps if hemothorax is mild, in this case, analgesics and hemostatic drugs are used. Also, substitution therapy with urgent blood transfusion gives a good effect, if hemothorax is moderate or even severe. Fibrinolytic agents are introduced to treat HT infection, they are also prescribed for the prevention and treatment of coagulated hemothorax, and immunocorrective and symptomatic treatment can also be used.
Small hemothorax can be eliminated very quickly and without consequences with conservative methods of treatment. But in that case, if a repeated examination revealed a positive test of Ruvilua-Gregoire, then there is no way to do without surgical intervention.
Surgical treatment of hemothorax
The operation is indicated to the patient in such cases:
- if bleeding continues inside the pleura;
- hemothorax curled up and interferes with the expansion of the lung;
- if there is a repeated accumulation of blood after taking a puncture;
- there is a blood discharge through pleural drainage, and its volume is about 500 ml in 2-3 hours;
- damaged vital organs.
Treatment of hemothorax is based on the characteristics of the etiological factor, the intensity of bleeding and the severity of hemorrhagic shock. Open penetrating injuries of the lung and other organs of the chest require urgent surgical intervention against the backdrop of complex anti-shock therapy, which includes not only therapeutic analgesia, but also the fight against acute form of anemia and hypoxia.
The operation is needed for such purposes:
- stop the bleeding;
- eliminate damage to internal organs;
- remove excess blood;
- to apply drainage for accelerated lung expansion;
- for sanitation of the pleural cavity with antiseptics.
But what forecasts do doctors give to patients who underwent hemothorax surgery?
Prediction and prevention of hemothorax
The success of therapy for hemothorax depends on the nature of the injury or pathology, the intensity of bleeding, and timely assistance. The prognosis is favorable for patients with mild or moderate hemothorax. Coagulated hemothorax can threaten the development of pleural empyema, but continued bleeding or a single large blood loss can lead to death.
The consequence of hemothorax can be the formation of massive pleural adhesions, which lead to a restriction of diaphragm mobility. In this case, it is recommended that all patients who have had this condition should go swimming and do regular breathing exercises.
Prevention of hemothorax involves the prevention of chest injury, consultation with a doctor of patients with thoracoabdominal trauma, control of hemostasis during surgery on the lungs and mediastinum.
Conclusion
Summing up, I want to say that the Ruvilua-Gregoire test is one of the most important studies in hemothorax. Bleeding in the pleural region is a very serious condition requiring urgent treatment by a doctor. That is why it is better to seek qualified help at the first symptoms or immediately after an injury, otherwise inaction can be fatal.