About 10 percent of people with household chest injuries enter traumatology. In this case, various injuries of 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 acting 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 was injured in the chest 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 peritoneal pleura is preserved in the victim), as well as penetrating, that is, a penetrating wound in the pleural cavity is 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 located behind the chest.
With any of the listed types of injuries, the person is disturbed by the depth and rhythm of breathing, the victim cannot clear his throat, which, in turn, leads to hypoxia.
Blunt closed chest injuries can result from shock, compression, or concussion. The nature and extent of damage depends on the intensity of the injury and the mechanism of action on the affected area.
Chest injuries
Most often, trauma doctors face closed chest injuries with bone fractures. If a person received a blow to the area of 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 a hemorrhage in the muscles, the victim can only breathe superficially, because a deep breath significantly enhances pain. To make an accurate diagnosis, healthcare providers need to examine the lungs using fluorography.
As a first aid for 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 does not dissolve, the surgeon will need to make an incision in the skin. A working person becomes after about 21 days of treatment.
Concussion
A minor concussion resulting from chest injuries (ICD-10 attributes codes S20-S29 to them) can do without consequences. The patient only for a short time, after physical contact, will feel a lack of air, as well as impaired breathing. After some time, the body recovers and returns to the normal rhythm of life.
Severe tremors are characterized by hemorrhage in the internal organs, accompanied by a mild shock. The condition of the patient after the injury is extremely serious, he has cold limbs, a frequent pulse and breathing. Sometimes such injuries are fatal. To save a person, you need to resort to intensive care as soon as possible. If necessary, it is necessary to immediately carry out resuscitation measures, after which health workers should resort to symptomatic therapy.
Bone fractures
Rib fracture occurs most often due to direct chest injury. It can be a strong pressure from a massive object or a sharp blow. In medical practice, there are 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 sideways bones of the paravertebral line are injured.
Bilateral rib fractures most often occur after a severe accident or during a natural disaster, such as an earthquake, when the victims find themselves under the rubble of buildings. Such injuries are often exacerbated by the fact that the sharp end of a broken bone can damage blood vessels, pierce a lung, and even perforate the pleura.
Symptoms of a fractured rib
Victims who have received chest injuries usually complain of sharp and severe pain at the lesion sites. At the same time, pain sensations increase significantly if the patient takes a deep breath. The state of the accident 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), and also from pain shock.
If a person entering a medical institution has one rib broken, then his general condition is satisfactory. A person cannot inhale a large amount of air due to pain, is unable to cough, release mucus from the lungs, as a result of which it accumulates in the upper respiratory tract. If a person does not receive medical assistance in the near future, he may be at risk of pneumonia. Also a symptom of a bone fracture in the sternum is hemoptysis.
To help with chest injuries and fractures of the ribs, you need to find the points where the person feels the maximum pain. To find the location of the fracture, you should find the place where the chest is easily compressed when pressed, and the pain is significantly increased. This is the place of bone injury.
To determine whether a closed chest injury led to a double fracture of one of the ribs, you should know that during inhalation, the damaged area sinks, and when exhaled, on the contrary, it aligns. In this case, the victim feels severe pain, he is unable to take a strong breath. This condition negatively affects the nature of breathing, the work of internal organs in the body is disrupted.
Numerous rib fractures, especially bilateral, cause severe respiratory failure, hypoxia, and pleuropulmonary shock. In order to make an accurate diagnosis, it is necessary to fix the body correctly for fixing the fracture, the operation to remove bone fragments, the patient must be sent for x-ray, percussion. In the absence of qualified care, the patient can quickly develop numerous complications, such as pneumothorax or hemothorax.
Simple fracture treatment
If only one rib is broken as a result of a chest injury, and the victim does not have any complications, then the attending physician prescribes an anesthetic. It is also necessary to take measures to improve breathing conditions. The patient should take drugs that serve to prevent pneumonia.
The patient in the hospital is moved to a bed in a half-sitting position. To alleviate suffering, the patient is given a local blockade with Novocaine solution, and analgesics are also used. After the painkillers have worked, the excursion of the chest improves significantly, breathing becomes even and deeper. The patient is capable of clearing his throat. The blockade should be repeated several times.
After several days of rest, the patient is sent to therapeutic exercises, as well as symptomatic therapy.
Thanks to modern methods of treatment in an injured patient, the ribs grow together within a month. Full recovery of the body occurs 2-3 months after the injury.
Multiple Fracture Treatment
For fractures of four or more ribs, doctors carry out complex treatment, which is carried out depending on the severity of the injury. To ensure a stationary state, a thin vascular catheter is inserted into the paravertebral region by piercing the skin with a needle. Such a tube is glued to the patient's body with a band-aid, the second end is brought out to the shoulder girdle. If the victim feels acute pain, then about 20 ml of the pain medication is injected through the catheter (usually it is a Novocain solution). Depending on the severity of the injury, a medicine that helps a person to relax is used up to 5 times a day.
If a patient has respiratory distress due to a severe injury to the chest organs, then in this case, doctors use a vagosympathetic blockade according to A. Vishnevsky, and also carry out intensive therapy. Resuscitation is sometimes required, namely intubation and respiratory depression.
If a person during the study of bone images found double fractures of the ribs, then the injured bones are fixed with Kirschner spokes, which the surgeon passes through the skin. In some cases, the metal frame of the knitting needles is fixed on the falling section of the sternum. Reliably fixed ribs fuse for several months.
For comprehensive treatment of the victim, oxygen therapy is used, antibiotics are prescribed, and, if necessary, mucus is aspirated from the trachea.
Possible complications
Multiple fractures in the chest area are often accompanied by complications, such as valvular pneumothorax, hemothorax, as well as subcutaneous emphysema.
What is hemothorax?
Hemothorax is a collection of blood in the pleural region, which has flowed from damaged muscles or intercostal vessels.
If 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 profuse bleeding:
- Total, which is extremely rare. With this disease, up to 1.5 liters of blood is released.
- With an average hemothorax, blood forms in the area of the scapula. The volume of accumulated liquid reaches 0.5 liters.
- Small is characterized by the accumulation of not 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
It is quite difficult to detect a small accumulation of blood, because there are no special signs with this disease. During a visual examination of the patient on the body, only signs of rib fracture are clearly visible. However, if hemothorax is not detected in time, then it can quickly develop into a more complex disease.
As a result of blood accumulation in one place with moderate hemothorax, one of the lungs is compressed, which leads to hypoxia, severe shortness of breath, sometimes a hemodynamic disorder is recorded in a patient. Often the victim's body temperature rises to 39 degrees.
Treatment methods
Hemothorax is one of the complications resulting from a fracture of the ribs, so the patient is prescribed complex treatment. With a small accumulation of blood, it resolves with time on its own, 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 immediately be removed from the body using a special needle. If this is not done on time, the fluid may settle in a clot, and 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 who is admitted to a medical facility is punctured, and then a Ruvilua-Gregoire test is performed to determine how fresh the stagnant blood is. Next, the patient is transferred to the operating table for thoracotomy (opening the chest).
Sternum 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 trauma in this place, the displacement of bone fragments is negligible.
Symptoms of sternal damage
The victim complains of pain in the chest area, which is much worse when inhaling. The patient also experiences acute pain during coughing. To make a diagnosis, it is necessary to palpate to determine the location of the fracture, and also to find out if there are small fragments of bone. An x-ray is also taken in the lateral projection of the chest.
How to treat
The doctor introduces 10 ml of Novocaine solution to the place where the fracture is detected. If the revealed fracture without displacement, small fragments of bones are absent in the human body, then special treatment is not required. The bones will heal in a month. If a displacement of a part of the chest after an injury is found, then the patient should be put on a bed with a shield. A special medical roller must be placed under the thoracolumbar spine so that the injured bones return to their original position.
If the diagnosis is correct, and the patient was provided with qualified help, then the bones will heal after 4 weeks. After 1.5 months, the affected person becomes fully able to work.
Sometimes patients with a broken sternum need immediate surgical intervention. The patient is sent to the surgical department if, after fixing the broken bones, the pain does not go anywhere, while the person has a disorder in the work of internal organs.