First aid for a lung injury. Causes of lung damage. Wounds and ruptures of the lung

Due to anatomical features breast organs, with penetrating wounds, the lungs are most often (70-80%) damaged. In pathogenesis it is vital important disorders in this case, pneumothorax comes to the fore with the exclusion of the large alveolar surface from its function external respiration. Tension pneumothorax leads to mediastinal displacement with impaired blood flow large vessels breasts

Lung damage from stab wounds most often localized in lower parts: on the left - on the anterolateral surface of the lower lobe (V, less often IV segments, as well as VII, VIII and IX segments), on the right - on the posterolateral surface of the middle and lower lobes (VII, VIII, IX segments, less often - IV, V and VI segments ).
The wound channel in the lung with stab wounds can be blind, through and tangential (tangential).

Blind injuries Depending on the depth, they are divided into superficial and deep. The criteria for such division are very relative; in a 2005 publication, we divided stab wounds of the lungs into superficial (up to 5 mm deep), shallow (from 5 to 15 mm) and deep (more than 15 mm). However, this division was used in relation to the possibilities of thoracoscopic interventions for chest wounds, and therefore was of a private nature.

More significant is localization of stab wounds. Their location in the peripheral zone of the lung (regardless of whether they are blind or through) is not accompanied by heavy bleeding or the entry of air into the pleural cavity. Wound surface layers lung tissue leads to moderate bleeding, which quickly stops on its own. Wounds of the hilar zone of the lungs, on the contrary, are often accompanied by damage to the vascular network of the lungs and bronchial tree, which makes them very dangerous.

For stab wounds of the lung characteristic is the slit-like shape with smooth edges and moderate bleeding. In case of a deep wound, due to the obstructed outflow of blood from the wound channel, hemorrhagic impregnation occurs in the circumference. With penetrating gunshot wounds of the chest, only 10% of the wounding projectile passes through the pleural sinuses, bypassing the lung. In the remaining 90% lung tissue damaged to one degree or another.

Gunshot wounds of the lung divided into through, blind and tangent. Damage great vessels and large bronchi, according to military field surgeons, do not occur often. However, we believe that the wounded with such injuries die faster than they are in the field of view of surgeons.

Porous and elastic lung tissue, which offers little resistance to the wounding projectile, is damaged only in the immediate vicinity of the wound channel. Bullet wounds in the lung parenchyma form a channel with a diameter of 5 to 20 mm, filled with blood and detritus. When the ribs are damaged, small fragments of them are often located in the wound channel, as well as infected (contaminated) foreign bodies - scraps of clothing, parts of a wad (in case of a shot wound), fragments of bullet casings.

In a circle wound channel after a few hours, fibrin falls out, which, together with blood clots, fills the wound channel, stopping air leakage and bleeding. The zone of traumatic necrosis around the wound drip does not exceed 2-5 mm, the zone of molecular concussion with a diameter of 2-3 cm is represented by thrombosis of small blood vessels and hemorrhages into the lung tissue. Focal hemorrhages and ruptures of the interalveolar septa lead to the occurrence of atelectasis.

In a significant number of observations, with a smooth course, hemorrhage into the lung tissue resolves within 7-14 days.

However, when wounded by high-velocity bullets extensive ruptures and crushing of the pulmonary parenchyma occur. In this case, fragments of damaged ribs, which have received high kinetic energy, cause additional numerous damage.

In the vast majority of observations for lung injuries hemopneumothorax immediately appears, the volume of hemothorax depends on the caliber and number of damaged blood vessels, and the volume of pneumothorax depends on the caliber and number of damaged airways.

Extensive destruction of the lung parenchyma observed with shrapnel wounds and mine-explosive trauma. Shell and mine fragments form wound channels irregular shape with tissue crushing, depending on the size of the fragment and the speed with which it penetrated the body.

Sometimes whole share or even most of the lung are areas of broken tissue soaked in blood. Such traumatic hemorrhagic infiltration, with a favorable course of the post-traumatic period, is organized over time with the outcome of fibrosis. But much more often the process occurs with necrosis, infection and the formation of lung abscesses.

One of the first publications good outcome with abscess formation of lung tissue after a gunshot wound belongs to N.I. Pirogov. He cites the case of the Marquis De Ravagli, who, 10 years after a gunshot wound to his lung, had a wad of tow come out with cough and pus, which caused the formation of an abscess.

Of the 1218 patients admitted to Institute with lung injuries, 1064 (87.4%) had stab wounds, 154 (12.6%) had gunshot wounds. The vast majority of the wounded had stab wounds to the superficial layers of the parenchyma (915 observations, accounting for 75.1%). However, in 303 (24.9%) the depth of the wounds was 2 cm or more, including in 61 (5%) reaching the root zone and lung root. When analyzing this group of victims, it was revealed that left-sided injuries predominated (171 victims, accounting for 56.4%). Injuries right lung noted in 116 (38.3%), bilateral wounds were present in 16 victims (5.3%). In 103 patients of this group, the wounds were of a gunshot nature, and in 56 (54.4%) they were blind, in 47 (45.6%) - through.

Length of wound channels 303 victims are presented in the table, while the number of wounds exceeds the number of observations due to multiple lung injuries. The table shows that the length of the wound channel in our observations ranged from 2 to 18 cm, including wounds with cold steel. In more than 50% of cases, the length of the wound channel was 4-8 cm.

From the table it follows that the victims with established lung injury most often there were vascular injuries at the same time chest wall, diaphragm and heart.

Quite often there were rib damage, including injuries from cold steel. Damage to the thoracic vertebrae and spinal cord met only with gunshot wounds.

From the abdominal organs simultaneously with a lung injury Injuries to the liver and stomach were most often observed. Of the combined injuries, most often there were injuries to the upper and lower extremities.

Lung injuries according to the OIS scale are distributed as follows (the volume of hemothorax is not taken into account here):

The presence of bilateral injuries increases the severity of the injury I-II degrees one more degree.

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Injury resulting from a penetrating stab or gunshot wound to the chest.

Pathological anatomy. At stab wounds damage to the lung tissue is mainly limited to the zone of the wound canal; in case of gunshot wounds, in the circumference of the wound canal containing blood clots, tissue fragments and foreign bodies, there is a zone of traumatic necrosis, and to the periphery of it there is a zone of molecular concussion and hemorrhages.

Pathophysiological disorders in case of lung injuries, they are determined by: air entering the pleural cavity through a wound of the chest wall and from damaged airways and collapse of the damaged lung, i.e. traumatic pneumothorax; hemorrhage into the pleural cavity from damaged vessels lung and chest wall, i.e. traumatic hemothorax and blood loss; blood getting into airways with the occurrence of aspiration atelectasis.

Clinic. Signs of lung damage from chest wounds are hemoptysis, release of gas bubbles through the wound and the presence of subcutaneous emphysema in its circumference, chest pain when breathing, shortness of breath and other signs respiratory failure, symptoms of blood loss with significant intrapleural or intrabronchial bleeding.

Diagnostics. Physically, signs of pneumo- and hemothorax can be determined, which are confirmed by x-ray examination. The latter can also detect foreign bodies in the lung (in case of a gunshot wound) and gas accumulation in soft tissues chest wall.

Treatment has the main task of eliminating pneumo- and hemothorax and completely straightening the damaged lung. In the absence of gas and blood accumulation in pleural cavity and significant damage to the chest wall, it can be purely symptomatic. With minor, spontaneously sealed lung damage and small hemo- and pneumothorax, a sealed puncture of the pleural cavity is sufficient to evacuate air and blood. If pleural exudate subsequently accumulates (traumatic pleurisy), puncture with evacuation of fluid and administration antibacterial agents re-produced. For more significant injuries, when the puncture is not able to provide evacuation of air entering through the lung wound, as well as for tension pneumothorax, the pleural cavity is drained with a thick drainage tube(with an internal diameter of at least 1 cm), which is connected to the system for continuous active aspiration. This measure ensures lung expansion and elimination of hemopneumothorax in the vast majority of cases. Indications for surgical intervention are: a large defect of the chest wall, causing an open pneumothorax and requiring surgical treatment with a blind layer-by-layer suture; continued bleeding into the pleural cavity or Airways; inability to create a vacuum in the pleural cavity and ensure expansion of the lung for 2-3 days of constant aspiration through drainage, intractable tension pneumothorax; formation of massive blood clot in the pleural cavity (“coagulated hemothorax”), which cannot be melted and aspirated during use local therapy fibrinolytics; large foreign bodies in the lung. The intervention consists of surgical treatment chest wall wounds, thoracotomy under intubation anesthesia, hemostasis and suturing of lung tissue wounds. If damaged, large bronchi and vessels are also sutured. In cases of significant crushing of the lung tissue, atypical lung resection may be indicated, and in in rare cases- forehead - or even pneumonectomy.

When the lungs are injured, first of all, it is necessary to insert some kind of tube into the wound, which is open on both sides. This could be a catheter, a pen, or another suitable item that is at hand. You just need to disinfect it first. This will help the excess air escape.

Orthopedist-traumatologist: Azalia Solntseva ✓ Article checked by doctor

Bullet wound

Such damage occurs due to fractured ribs and a simultaneous wound to the chest area. The situation is dangerous because it arises heavy bleeding and pneumothorax of valvular or open type.

These symptoms are very dangerous for maintaining the life of the victim.

They can cause complications that require urgent surgical intervention.

At bullet wound lungs when the victim has closed damage chest, urgently needs to be applied pressure bandage. This should be done during maximum exhalation. These actions are performed when the ribs and sternum are broken.

If the victim has a significant closed pneumothorax, a puncture of the pleural cavity is performed. The procedure must be done when the mediastinum is displaced. Then be sure to perform aspiration of air from the cavity.

For subcutaneous emphysema, which is often a consequence of pneumothorax, there is no emergency treatment.

In case of a bullet wound to the lungs, you should very quickly cover the wounded area with a sealing bandage. A gauze napkin is placed on top of it. big size folded many times. After this, it should be sealed with something.

When transporting the victim to a medical facility, he should be placed in a semi-sitting position. If possible, he is injected locally with novocaine for pain relief even before he is taken to the doctor.

If the victim is in in a state of shock, his breathing is impaired, then performing a vagosympathetic blockade according to Vishnevsky on the side that was injured will be very effective.

Video

Penetrating trauma

Symptoms of penetrating - bleeding from a wound on the chest, characteristically the formation of bubbles - air passes through the wound.

If your lungs are injured, you must first do the following:

1. First, you should make sure that there is no foreign object in the wound.
2. Then you need to press your palm against the damaged area to limit the flow of air.
3. If the victim has a through wound, the exit and entrance holes to the wound should be closed.

1. Then you should cover the damaged area with material that allows air to pass through and secure it with a bandage or plaster.
2. The patient should be placed in a semi-sitting position.
3. It is necessary to apply something cold to the wound site, but first apply a pad.
4. If there is a foreign body due to a stab wound to the lung, then it is necessary to fix it with a roller made from improvised materials. You can secure it with cloth or tape.
5. It is strictly forbidden to independently remove stuck foreign bodies from the wound. After the procedures have been completed, the patient should be taken to the doctor.

Video

Closed wounds

A closed type of chest injury is characterized by a fracture of the chest bones. Closed heart injury is also typical, while in chest cavity there is no open wound.

This injury is accompanied by traumatic pneumothorax, hemothorax or hemopneumothorax. At closed injury In the chest, the victim develops traumatic subcutaneous emphysema and traumatic asphyxia.

A closed chest injury is an injury to the rib cage. In this case, the organs in the chest are injured, but skin remain intact.

These injuries often occur as a result of one or more blunt force injuries or surfaces resulting from a traffic accident. They often injure the chest when they fall from a height, during a beating, a sharp one-time or numerous short-term, or prolonged compression a patient in a crowd of people or rubble.

Closed form

1. Promedol or analgin should be administered intramuscularly.
2. Inhalation anesthesia with nitrous oxide and oxygen.
3. Oxygen therapy for pain relief.
4. You can use a circular bandage made from a plaster or an immobilizing bandage. They should be used only when no deformation of the rib frame is visible.
5. When the condition worsens significantly, shortness of breath increases, and the mediastinum moves to the undamaged side, there is a need to perform a puncture of the pleural cavity. This will help convert a tense pneumothorax into an open one.
6. Any medications for the heart are effective. Antishock agents can be used.
7. After assistance has been provided, the patient should be taken to a medical facility.
8. The patient must be transported on his back or on a stretcher. The upper half of the body must be raised. The victim can be taken to the doctor in a half-sitting position.

What do we have to do

Lung injuries can be open or closed.

The latter occurs when the chest is sharply compressed.

It can also occur from a blow with a blunt object or a blast wave.

The open type of damage is accompanied by open pneumothorax, but maybe without it.

Injury to the lungs due to closed trauma is determined by the degree of damage. If they are seriously injured, bleeding occurs and the lung ruptures. Hemothorax and pneumothorax occur.

An open wound is characterized by a rupture of the lung. It is characterized by damage to the chest.

Depending on the characteristics of the damage, there are different degrees gravity. It is not easy to see a small, closed, minor chest wound.

When the lungs are damaged, the victim experiences hemoptysis, subcutaneous emphysema, pneumothorax and hemothorax. It is impossible to see accumulated blood in the pleural cavity if there is no more than 200 ml there.

The techniques that can be used to help the victim are varied. Their choice is determined by the severity of the damage.

The main goal is to quickly stop the bleeding and restore normal breathing and cardiac activity. At the same time as treating the lungs, the chest walls should also be treated.

Causes

Closed injuries are the result of an impact on a hard surface, compression, or exposure to a blast wave.

The most common circumstances in which people receive such injuries are road traffic accidents, unsuccessful falls on the chest or back, blows to the chest with blunt objects, falling under rubble as a result of collapses, etc.

Open injuries are usually associated with penetrating wounds from a knife, arrow, sharpening, military or hunting weapon, or shell fragments.

Except traumatic injuries, possible defeat physical factors, for example, ionizing radiation. Radiation damage to the lungs usually occurs in patients receiving radiation therapy for cancer of the esophagus, lungs, and breast. The areas of lung tissue damage in this case topographically correspond to the irradiation fields used.

The cause of damage may be diseases accompanied by rupture of weakened lung tissue when coughing or physical effort. In some cases, the traumatic agent is foreign bodies of the bronchi, which can cause perforation of the bronchial wall.

Another type of injury that deserves special mention is ventilator-induced lung injury, which occurs in patients receiving mechanical ventilation. These injuries are caused by oxygen toxicity, volutrauma, barotrauma, atelectotrauma, and biotrauma.

Diagnostics

External signs of injury: the presence of hematomas, wounds in the chest area, external bleeding, air suction through the wound channel, etc.

Physical findings vary depending on the type of injury, but most often there is decreased breathing on the side of the affected lung.

For correct assessment the nature of the damage requires a chest x-ray in two projections.

X-ray examination reveals mediastinal displacement and lung collapse(with hemo- and pneumothorax), spotty focal shadows and atelectasis (with lung bruises), pneumatocele (with rupture of small bronchi), mediastinal emphysema (with rupture of large bronchi) and others characteristic features various damages lungs.

If the patient's condition allows and technical capabilities, it is desirable to clarify the X-ray data using computed tomography.

Bronchoscopy is especially informative for identifying and localizing bronchial rupture, detecting the source of bleeding, foreign body etc.

Upon receipt of data indicating the presence of air or blood in the pleural cavity (based on the results of fluoroscopy of the lungs, ultrasound of the pleural cavity), a therapeutic and diagnostic pleural puncture can be performed.

In case of combined injuries, it is often necessary additional research: plain radiography abdominal organs, ribs, sternum, fluoroscopy of the esophagus with barium suspension, etc.

In case of unspecified nature and extent of lung damage, diagnostic thoracoscopy, mediastinoscopy or thoracotomy are used. At the diagnostic stage, a patient with lung damage should be examined by a thoracic surgeon and traumatologist.

First aid for lung injuries

There is no article in the Criminal Code of the Russian Federation directly providing for criminal liability for a knife wound. Is it so? Knife wounds are considered bodily injuries. Answers to questions about the liability that may arise for stabbing are found in Chapter 16 of the Criminal Code of the Russian Federation “Crimes against life and health.” Legal illiteracy can play a role cruel joke and even with the Criminal Code at hand, it is not possible to determine the possible punishment, as well as assess the need to immediately seek qualified legal assistance for a person who is far from the code of criminal laws of the country.

Types of bodily injury

Bodily injury is considered to be a disruption of the functioning of the human body, as well as harm or change in the anatomical structure of the body that arose under the influence of various factors environment.

The legislation classifies injuries as follows:

• lungs;
• moderate severity;
• heavy.

Since the harm is caused to health, accordingly, the degree of liability is determined in proportion to the damage caused by the impact attack, and not by the amount of damage, the area affected, or the nature of the objects that caused the injury.

No lawyer, no matter how highly qualified he may be, can accurately determine the nature of the harm caused to the human body. This right assigned by law to such a category of professionals as a forensic medical expert who is an employee medical institution or having permission to conduct special research and for the provision of medical services.

Minor injuries are characterized by a short-term deterioration in health or an insignificant loss of ability to work. Moderate injuries are characterized by significant loss of ability to work in a ratio of less than one third of general condition health, as well as long-term harm to the health of the victim.

When defining severe injuries, the legislation provides a list of specific human organs, injuries of which entail a threat to the life of the victim, loss of ability to work by at least one third, absolute loss of professional suitability, cessation of certain physical conditions(pregnancy).

Unfortunately, in our country, a fairly common type of crime that encroaches on human life and health is stabbing.

Most often they occur at home, as a result of abuse alcoholic drinks. At the same time, recognition of a knife through an examination as a bladed weapon does not constitute criminal liability. a necessary condition.

Depending on the attitude of the accused person to the crime he has committed, the act is qualified as attempted murder or assault. varying degrees damage.

Most often, responsibility for this type attacks on human life and health occur under the following articles:

1. Causing grave damage (Article 111 of the Criminal Code of the Russian Federation).
2. Causing medium degree damage (Article 112 of the Criminal Code of the Russian Federation).
3. Causing minor injuries (Article 115 of the Criminal Code of the Russian Federation).

Each of the described articles contains in the preamble a qualifying feature that entails a higher penalty. To commit a crime, weapons or objects acting as weapons are used.

An ordinary household knife does not have the characteristics of a bladed weapon. The thickness, length of the blade and handle are not intended for injecting. Despite this, the knife acts as a weapon.

Without proper knowledge in the field of medicine, it is very difficult to determine the nature of the damage and possible consequences their application for the life and health of the victim. At the same time, liability comes for causing severe and moderate injuries that occurred under the influence of passion (Article 113 of the Criminal Code of the Russian Federation) or when exceeding the limits of necessary defense (Article 114 of the Criminal Code of the Russian Federation). Responsibility is significantly different from that which occurs for the same actions that led to the death of the victim (Articles 105, 107, 108, 109 of the Criminal Code of the Russian Federation).

For example, a person is injured in abdominal cavity, even if it is not accompanied by heavy bleeding, may end fatal, if vitally important internal organs. However, without special examination qualified specialist victim, it is impossible to determine which organs are affected and what consequences this will lead to.

At first glance, a slight penetrating leg wound, accompanied by significant blood loss, without medical assistance can lead to the death of the victim. In this case, the perpetrator will be held liable for premeditated murder or manslaughter.

Procedure for filing a police report

Legislatively, the procedure for filing a statement with the police is regulated by Article 141 of the Code of Criminal Procedure of the Russian Federation.

It can be submitted in the following forms:

• oral;
• written.

Application forms submitted above are equivalent. Oral form involves the mandatory entry of data into the protocol from the words of the applicant, and in the absence of such a possibility, a report from a law enforcement official. Verbal statements are also called crime reports. In both forms prerequisite acceptance is the presence of the applicant’s installation data.

Anonymous messages are not considered as grounds for initiating criminal proceedings. Applications are subject to mandatory registration with established by law ok. The maximum period for their consideration for acceptance legal decision is a period of 30 days.

The result of consideration law enforcement agency May be:

1. Criminal proceedings.
2. Issuance of a decision to refuse to initiate proceedings in the absence of corpus delicti.
3. Transfer of the message to the jurisdiction or to the court.

We should not forget the fact that it is the responsibility of the doctor providing medical care the victim, includes notifying the competent authorities about all “criminal” injuries: gunshots, knife wounds, beatings, and so on.

Accordingly, without the intention of reporting an offense, it will not be possible to avoid communication with law enforcement officers regarding the nature of the injuries received. At the same time, in order to initiate a criminal case for causing grievous or moderate bodily harm, a statement from the victim is not required.

Proceedings for these crimes are conducted in public, regardless of the wishes of the victim.

The sanctions in the articles providing for punishment for causing damage to life and health include the following types:

Responsibility is listed from the mildest, which occurs for causing minor bodily injuries, to the most severe, indicated by the additional parts of Article 111 of the Criminal Code of the Russian Federation.

We should also not forget that the pre-trial investigation authorities and the court itself, when deciding on the choice of a preventive measure, will take into account mitigating and aggravating circumstances.

In addition to the mitigating circumstances specified in Article 61 of the Criminal Code of the Russian Federation, when assigning punishment, the reconciliation of the accused with the victim will also be taken into account; in this case, a written statement from the victim about the absence of claims against the person under investigation is welcomed.

In case of qualification stab wound grave or moderate crime, criminal proceedings will be continued upon receipt of severe or moderate bodily injury by a person, regardless of the wishes of the victim.

If an influential person is involved in a criminal trial as an accused, or has certain material benefits. There are often so-called cases of “delaying out” procedural actions at the stage of pre-trial proceedings or directly when considering a crime in judicial procedure.

In this case, the most effective methods of acceleration are:

• involving the media in the process;
• appealing the actions of police officers to the prosecutor's office ( General Prosecutor's Office or territorial representation).

There is also a procedure for petitioning higher authorities, which are entrusted by law with the function of monitoring the actions of institutions of first instance, but this practice may be ineffective due to the interest and coherence of actions of representatives of the law enforcement system in order to obtain benefits.

Based on the nature of crimes that harm human life and health, taking into account the parties involved in these offenses, the most important universal recommendations for both the victim and the accused will be:

• immediate request for qualified legal assistance;
• involvement in forensic medical examination independent expert;
• commission at the pre-trial stage of all necessary actions, which can be taken into account as mitigating or aggravating circumstances when assigning punishment.

If intent is proven in the stabbing and the act is qualified as attempted murder, reconciliation of the parties to stop judicial proceedings will not be enough, no matter what form it comes in. It is worth noting that the condition alcohol intoxication will be accepted by the court as an aggravating circumstance.