Chest Trauma

1. Classification of thoracic traumatismelot

Thoracic injuries are injuries to the chest and inside the viscera caused by a traumatic agent .
For proper conduct traumatic thoracic injuries should be known variant of anatomical lesions , pathogenic mechanisms and physiological disorders . Therefore in thoracic trauma are three classifications :
I. Anatomical classification :
a) parietal thoracic injuries may be :
– With bone injuries ( rib fractures , clavicular ) ;
– No bone injuries ( bruises , abrasions , hematomas ) .
b ) Injury diaphragm can be :
– With perforated diaphragm;
– Without piercing the diaphragm.
c ) trauma injuries endotoracice :
– Lesions of the pleura , lung , tracheobronchial , cardiac or pericardiace ;
– With injuries of major vessels ( aorta , vena cava ) ;
– With and intrathoracic intercostal nerve .
II . Classification of pathogenic etiology is the most common . It is based on the integrity of the skin follows:
a) closed chest trauma (contusion ) ;
b ) open chest injuries ( wounds ) which may be caused by a gun or firearm , with the result that the chest wound , which can be :
– Non-penetrative when not interested and does not penetrate the pleura pleural cavity ;
– Penetrating , when interest pleura and the agent enters the pleural cavity vulnerable and can be :
• No visceral lesions ( heart , pericardium , large vessels ) ;
• The visceral lesions .
III . Pathophysiological classification divides the thoracic trauma :
– Trauma with physiological changes ( circulatory or ventilatory ) ;
– Trauma pathophysiological disorders ( cardio -circulatory failure , respiratory failure ) .

2 . Treatment of thoracic trauma

Treatment of thoracic trauma depends on the type of lesion , as follows:
a) – the primary stage of action ( first aid ) , consisting of: control bleeding , with vouchers rib fracture immobilization , control breathing and heart rate , getting injured in the outbreak of measures to protect the spine , oxygen , rapid transport to the hospital.
Victim will be maintained and then transported on a solid and mobilization will be done with extreme caution to avoid spinal cord injury .
In the emergency room ( ER ) is controlled freedom and assesses airway respiratory movements and blood circulation : it will install a central venous catheter to measure central venous pressure (PVC ) of fluid resuscitation therapy instituted and determined group and Rh the blood .
b ) secondary phase of action ( in-hospital ) to: medical history on how to produce injury and was vulnerable agent , is performed EKG , chest X-ray and ultrasound , examine the following assessment of rib fractures , pulmonary and cardiac lesions .

3 . Syndromes that may occur in thoracic trauma :

1 ) airway obstruction .
From the clinical point of view , the patient is in apnea, with intense thirst air and tachypnea .
As a means of emergency:
– To be the upper airways ( with a finger wrapped with a clean compress oropharyngeal and oral cavity ;
– If not breathing well is oro -tracheal intubation ;
– if you can not oro -tracheal intubation apply cricothyroidotomy , which is a maneuver dezobstrucţie airway or tracheostomy .
2 ) hypertensive pneumothorax occurs through an accumulation of air in the pleural cavity . The pressure created in the pleural space leading to lung collapse , dislocation mediastinal structures (especially the vena cava ) , decreased venous return and cardiac output .
From the clinical point of view , the patient ‘s dyspnea, pneumothorax occurs hypersonority the side , no vesicular murmur , hypotension, jugular turgid .
Treatment consists of :
– Introduction of a trocar in the pleura for decompression ;
– Introduction of a pleural drainage tube at the other end will be put in a bottle with water until air comes out on the tube ;
– Suture hole through which the tube was inserted .
3 ) Voucher thoracic rib fracture is the result of more than two ribs in at least two different places.
Clinical abnormalities occur lung ventilator filling , resulting in alveolar hypoventilation , hypoxia and hypercapnia followed .
Treatment consists of :
– Stabilizing the voucher cost plaster or surgical tape , external fixation or fixation with thin rods or pins ;
– Endotracheal intubation to ensure high costal breathing in vouchers .
4 ) Massive haemothorax which is a collection of blood in the pleural cavity .
Since clinically manifested by : hemorrhagic shock ( hypotension , tachycardia , pallor , cold sweat ) respiratory failure , pulmonary dullness to percussion , absence of vesicular murmur ; hemithorax opacification on radiography .
Therapeutic thoracentesis is necessary to evacuate the hematoma , cost or pleurostomă incision . If bleeding does not stop haemostasis is required by thoracotomy .
5 ) Pulmonary contusion is characterized by crushing a lung segment or lobe chest lung area so that no longer fills the air , leaving an inert area .
The diagnosis is established by the absence of breath sounds and dullness radiologically by area .
Treatment consists of :
– Extensive physiotherapy movements ;
– Endotracheal intubation
– Slightly higher pressure ventilation .
6) The tracheobronchial rupture occurs when interrupt the continuity of tracheobronchial tree .
Clinical extensive subcutaneous emphysema occurs in the cervical and thoracic ( gas bubbles enter the subcutaneous tissue ) .
Treatment consists of :
– Introduction of small needles under the skin to drain the gas bubbles purpose of stopping the phenomenon ;
– Thoracotomy with tracheal or bronchial suture gap .
7 ) diaphragmatic rupture can be large or small :
a) significant breaks occur: acute respiratory failure as part diaphragm breathing ; hypotension herniation of organs in the chest cavity from the abdominal cavity , dullness to percussion , noise -liquid in the thorax , reducing vesicular murmur .
b) small tear treatment is conservative .
Treatment consists of large ruptures : nasogastric tube , laparotomy , pleurotomie minimal; suture aperture.

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