Closed TRAUMA of the CHEST & abdomen. L.Yu.Ivashchuk

The closed damages of the chest are divided: Classification The closed damages of the chest are divided: І. According to the injury of other organs: Isolated trauma. 2. Combined trauma (craniocerebral, with damage of abdominal organs, with damage of bones).

ІІ. According to the mechanism of trauma: Contusion. 2. Compression. 3. Commotion. 4. Fracture.

ІII. According to the character of the chest viscerae damage: Without damage of viscerae. 2. With damage of viscerae (lungs, trachea, bronchi, esophagus, heart, vessels, diaphragm etc.).

IV. According to the character of complications: 1. Uncomplicated. 1) Early (pneumothorax, hemothorax, subcutaneous, mediastinal emphysema floative rib fracture, traumatic shock, asphyxia); 2) Late (posttraumatic pneumonia, posttraumatic pleurisy, suppurative diseases of lungs and pleura).

V. According to the state of cardiopulmonary system: 1. Without phenomena of respiratory failure. 2. Acute respiratory failure (of І, ІІ, ІІІ degree). 3. Without phenomena of cardiovascular failure. 4. Acute cardiovascular failure (of І, ІІ, ІІІ degree). VІ. According to the gravity of a trauma: 1. Mild. 2. Moderate. 3. Severe.

Rib fracture . Classification Central floative segment – a multiple rib fracture along parasternal or midclavicular lines. 2. Anterolateral floative segment – a multiple rib fracture along parasternal and anteaxillary lines. 3. Lateral floative segment – a multiple rib fracture along anterior and posterior axillary lines. 4. Posterior floative segment – a multiple rib fracture along postaxillary and paravertebral lines.

Rib fracture

Treatment Pain relief in closed trauma of the chest is achieved by means of different blocks: 1. Vagosympathetic block; 2. Alcohol - novocaine block of the site of fracture; 3. Paravertebral block. The methods of reduction of the skeleton of the flail chest are divided onto three groups: 1. External fixation of a movable segment by means of suturing for intercostal muscles and traction during 2-3 weeks; 2. Intrmedullary costal osteosynthesis; 3. Mechanical ventilation (often with positive end-expiratory pressure).

Posttraumatic pneumothorax Posttraumatic pneumothorax is the presence of air in a pleural space, caused by mechanical injury of lung or chest wall as a result of trauma. Classification І. According to extension of process: 1. Unilateral. 2. Bilateral. ІІ. According to degree of a lung collapse: 1. Partial (collapse of lung to 1/3 of its volume). 2. Subtotal (collapse of lung to 2/3 of its volume). 3. Total (collapse of lung exceeding 2/3 of its volume). ІІІ. According to the mechanism of occurrence: 1. Closed. 2. Open. 3. Valvular.

The diagnostic program 1. Complaint and history of the disease. 2. Physical findings. 3. Chest X-radiography.

Treatment A chest trauma, which complicated by pneumothorax with a partial pulmonary collapse (to 1/3 of volume) is indication to aspiration of air by means of thoracentesis. The cases, if the negative pressure in a pleural space is not obtained, and also subtotal, and total pneumothorax require closed drainage of a pleural space. Under the local anesthesia by solution of novocaine in ІІ space in the midclavicular line by means of a trocar in a pleural space inserted a plastic tube, which fixed to skin. The drainage connects to aspirative system or according to method of Bulau. In the majority of patients the pneumothorax liquidates in some hours, or during 1-2 days. The absence of effect (incomplete expansion of lung) of active aspiration, and also valvular closed pneumothorax is the indications to operative management – suturing of the pulmonary wound. .

ІІ. According to degree of hemorrhage: Hemothorax Classification І. According to extent: 1. Unilateral. 2. Bilateral. ІІ. According to degree of hemorrhage: 1. Small (the loss less 10 % of volume of circulating blood). 2. Moderate (loss of 10-20 % of volume of circulating blood). 3. Great (loss of 20-40 % of volume of circulating blood). 4. Total (exceeds 40 % of volume of circulating blood). ІІІ. According to duration of bleeding: 1. With persistent hemorrhage. 2. With the stopped bleeding. ІV. According to the presence of clots in a pleural space: 1. Coagulated. 2. No- coagulated. V. According to the presence of infection: 1. Not infected. 2. Infected (suppurative).

The diagnostic program Complaint and anamnesis of the disease. 2. Physical examination. 3. Chest roentgenograms in 2 planes. 4. Thoracentesis. 5. Investigation of a pleural content. 6. Test by Revilour-Greguar. 7. General blood analysis. 8. Biochemical blood analysis. 9. Determining of the blood group and Rh factor. .

Classification Subcutaneous emphysema is divided on: Localized. 2. Widespread. 3. Total.

Treatment Widespread and total subcutaneous emphysema requires the draining of subcutaneous space by plastic tubes in infra- and supraclavicular region, and also in the zone of the most expressed emphysema. Also performed the drainage of a pleural space. The subcutaneous emphysema resolves depending on its extent from several days to 2-3,5 weeks.

Complaint and the history of disease. 2. Physical findings. The diagnostic program Complaint and the history of disease. 2. Physical findings. 3. Chest X-radiography. 4. Diagnostic thoracentesis. 5. General blood and urine analyses. 6. Biochemical blood analysis. 7. Tracheobronchoscopy. 8. Tomography.