Knife wound to the lung. Knife wound to the lung area. How do doctors deal with a stab wound?

Lung injuries cause compression, tearing, or even rupture of the lung. These injuries are usually severe and dangerous. Since in pleural cavity air or blood begins to accumulate, the lung collapses. Due to the negative pressure in the pleural cavity, the lungs follow the expanding chest and at the same time stretch.

Symptoms

• Sudden stabbing pain in the chest.
• A ringing sound when tapping the damaged half chest.
• No breathing can be heard.
• When breathing, the chest does not rise.

Causes of injury

Lungs may be damaged by exposure external factors, most often an accident, as well as an explosion, shot, stab, etc. From the inside, the lung is usually damaged by swallowed foreign bodies.

Reason internal damage there may also be a disease in which weakened lung tissue ruptures due to severe cough or heavy physical activity.

Treatment of lung injuries

Minor damage to lung tissue usually heals on its own. If a large amount of air accumulates in the pleural cavity, a special needle is inserted into the chest wall to drain it. IN severe cases surgery is required to remove the damaged lung.

If you suspect a lung injury, you should immediately call an ambulance. If you have stabbing chest pain, shortness of breath, or blood in your coughed up sputum, consult your doctor immediately. Sometimes chest injuries occur at work, but the victim does not immediately realize that the lung has been damaged.

The doctor will use a phonendoscope to listen to the patient's chest. A loud and low sound during percussion (tapping) and inaudible breathing are almost always a symptom of a collapsed lung (atelectasis). An x-ray is taken to confirm the diagnosis.

Bronchoscopy can also help with diagnosis. If the patient’s condition is serious, then artificial ventilation and even surgery have to be used. The operation is necessary to restore lung function and save the patient's life.

Course of the disease

Minor lung injuries usually do not require treatment. If the injury is more severe, symptoms begin suddenly. Tissue fluid can accumulate in the lungs even if, during an external examination of the chest visible damage are missing. When blood vessels are damaged, blood accumulates in the pleural cavity (hemothorax). If both lungs are damaged, the patient's life is in great danger: he practically cannot breathe.

Chest wounds are almost always (except very minor) considered very dangerous. If the lungs are damaged, there is a danger of the lung collapsing (atelectasis). Atelectasis can be life-threatening.

Inhalation and exhalation during lung injuries

Inhalation phase: When the lung or chest wall is damaged, air enters the patient's pleural cavity when inhaling. Part of the damaged lung collapses (lung atelectasis occurs). The mediastinum and its organs shift to the opposite side, putting pressure on the other lung and thus disrupting its ventilation.

Expiration phase: If the chest wall is intact or only slightly damaged, air cannot escape through it when exhaling. Therefore, with each breath, the pressure in the pleural cavity increases. The mediastinal organs and trachea increasingly shift to the opposite side, and the diaphragm moves downwards, and the return is impaired venous blood to the heart.

Lung damage caused by foreign bodies

The lungs can be injured from the inside by foreign bodies. Therefore, if you swallowed any object, it is better to consult a doctor.

Thank you

Bullet wound is a serious injury in which the injured person must be provided with qualified first aid. For bullet wounds to any part of the body, first aid is provided in the same way.

When you find a person with a bullet wound, it is necessary, first of all, to see if he has severe bleeding, when blood literally flows from the wound like a fountain, a strong, intense stream. If such bleeding occurs, you should first stop it, and only then call an ambulance. If there is no such severe bleeding, then you should first call an ambulance, and only then begin to provide assistance. first aid.

If " ambulance“does not arrive within half an hour, then there is no need to call her in principle. In such a situation, you should provide first aid to the victim on the spot, and then arrange for his delivery to the nearest hospital. To do this, you can use your own car, passing vehicles, stretchers, etc. .

Algorithm for providing first aid to a victim with a bullet wound in any part of the body except the head

2. Do not give the victim anything to drink or eat if he is wounded in the stomach. You can only wet his lips with water;

3. The unconscious victim must be placed in such a way that his head is thrown back and turned slightly to one side. This position of the head will ensure patency respiratory tract, and will also create conditions for the removal of vomit outside;

4. Try not to move the victim's body, trying to give him the most comfortable position, in your opinion. Remember, the less movement the better for a gunshot victim. If you need access to help to provide assistance, various areas body of the victim, then move around him yourself;

5. Examine the victim and locate the bullet exit hole, if there is one. Remember that it is necessary to treat and apply a bandage to both openings - inlet and outlet;

6. If there is a bullet left in the wound, then do not try to get it out, leave any foreign object inside the wound channel. Trying to remove the bullet may cause increased bleeding;

7. Do not clean the wound of blood, dead tissue or blood clots, as this can lead to very rapid infection and deterioration of the wounded person's condition;

8. If prolapsed organs are visible from a wound on the abdomen, do not set them!

9. First of all, you should evaluate the presence of bleeding and determine its type:

• Arterial– blood is scarlet, flows out of the wound in a stream under pressure (creates the impression of a fountain), pulsates;
• Venous– blood dark red or burgundy color, flows out of the wound in a weak stream without pressure, does not pulsate;
• Capillary– blood of any color flows out of the wound in drops.

In case of a gunshot wound, the entire body is examined for bleeding, since it can be in both the entrance and exit areas.

Methods to stop bleeding:

• Arterial bleeding stop by clamping damaged vessel directly into the wound, followed by tamponade or application of a tourniquet. The tourniquet can only be applied to an extremity - an arm or a leg;
• Venous bleeding stop by squeezing the vessel with your fingers from the outside. To do this, the skin and underlying tissues are grabbed and the vessel is squeezed. It must be remembered that if the wound is located above the heart, then the vessel is clamped above the point of damage. If the wound is located below the heart, then the vessel is clamped below the point of damage. After stopping venous bleeding by compressing the vessel, it is necessary to tamponade the wound or apply pressure bandage. Pressure bandages can only be applied to the extremities;
  Important! If it is impossible to apply a tamponade, tourniquet or pressure bandage, then you will have to compress the vessel until an ambulance arrives or the victim is taken to the hospital.
• Capillary bleeding stop by applying a simple bandage or pinching the vessels with your fingers and holding them in this position for 5 to 10 minutes.

If you are alone with the victim, you will have to tear him or your clean clothes with one hand, and squeeze the damaged vessel with the other, preventing blood from flowing out. If there is someone else nearby, ask them to bring the cleanest things or sterile bandages.

Figure 1 – Wound tamponade to stop bleeding

Rules for applying a tourniquet. The tourniquet can only be applied to the arm or leg above the bleeding site. Any long and dense object can be used as a tourniquet, for example, an elastic band, tie, belt, etc. Be sure to put a thick cloth under the tourniquet or leave the victim’s clothes on (see Figure 2). Then the tourniquet itself is wrapped 2-3 times around the limb, tightening it tightly so that the vessel is compressed and the blood stops. The ends of the tourniquet are tied, and a note is placed under it with exact time overlays. The tourniquet can be left on for 1.5 – 2 hours in summer and 1 hour in winter. However, doctors do not recommend trying to apply a tourniquet to people who have never done this before, at least on a dummy, since the manipulation is quite complex, and therefore more often causes harm than good.

Figure 2 – Application of a tourniquet

Rules for applying a pressure bandage. Place a piece of sterile gauze in 8 - 10 folds or clean cloth on the wound and wrap it with 1 - 2 turns of any dressing material(bandage, cloth, torn clothes, etc.). Place a dense object with a flat surface on top of the wound (for example, a box, control panel, glasses case, bar of soap, soap dish, etc.) and wrap it tightly with a dressing. In this case, the object is literally pressed into soft fabrics so that he squeezes the damaged vessel and thereby stops the bleeding (see Figure 3).

Figure 3 - Applying a pressure bandage.

10. If the bleeding is arterial, then it should be stopped immediately, putting everything else aside, since it is deadly to humans. When you see a stream of blood, do not look for materials for a tourniquet, but simply stick your fingers directly into the wound, feel for the damaged vessel and pinch it. If, after inserting your fingers into the wound, the bleeding does not stop, then you should move them around the perimeter, looking for a position that will block the damaged vessel and thereby stop the bleeding. At the same time, when inserting your fingers, do not be afraid to widen the wound and tear some of the tissue, since this is not critical for the survival of the victim. Having found the position of your fingers at which the blood stops flowing, fix them there and hold them until you apply a tourniquet or perform tamponade on the wound. In the best way is wound tamponade, since a tourniquet in the hands of a person who has never applied it before can only cause harm. Tamponade can be done when the wound is located on any part of the body, and a tourniquet can be applied only to the arm or leg;

11. If the bleeding is venous, tightly squeeze the skin with the underlying tissues with your fingers, squeezing the damaged vessel. Keeping the vessel compressed, apply a tamponade or pressure bandage. Optimal method is tamponade, since it is simpler and can be applied to a wound of any location, and a pressure bandage only on the limbs;

12. If the bleeding is capillary, you can simply press it with your fingers and wait 3 - 10 minutes until it stops. Or you can simply ignore capillary bleeding by applying a bandage to the wound;

13. If Dicynon and Novocaine (or any other painkiller) are available, then they should be injected into the tissue near the wound, one ampoule at a time;

14. Cut or tear clothing around the wound to provide access to it;

15. If prolapsed internal organs are visible from a wound on the abdomen, they must be carefully collected in a bag or a clean cloth, which is glued to the skin with tape or adhesive tape;

16. The skin around the entrance and exit holes of a bullet wound (or only the entrance, if the bullet remains in the body) must be treated with any antiseptic available at hand (for example, Furacilin, potassium permanganate, Chlorhexidine, hydrogen peroxide, vodka, wine, tequila, beer or any alcohol-containing drink) . If there is no antiseptic, then the skin around the wound should be washed with water (well water, spring water, mineral water from a bottle, etc.). Processing is carried out as follows - on small area Antiseptic or water is poured onto the skin, and then the area is carefully wiped with a clean rag, gauze or bandage in the direction from the edge of the wound to the periphery. Then moisten the adjacent area of ​​skin and wipe it again with a cloth. For each area of ​​skin, tear off a new piece of cloth or bandage. If the fabric cannot be torn, then a new, previously unused, clean piece should be used to wipe each subsequent area of ​​skin. big rag. In this way, wipe the entire perimeter around the wound;

17. If possible, lubricate the skin around the wound with brilliant green or iodine;

18. Do not pour antiseptic, water, iodine or brilliant green into the wound! Streptocide powder can be poured into the wound, if available;

19. If it is impossible to treat and lubricate the wound with brilliant green or iodine, then there is no need to do this;

20. After stopping the bleeding and treating the wound, it is necessary to apply bandages to the entrance and exit holes (or only to the entrance, if the bullet is inside the body). If you do not have experience applying a bandage to two wounds at the same time, different sides body, then don't try to do it. It is better to bandage one wound first, and then the second, doing this separately;

21. Before applying a bandage, cover the wound with a piece of clean cloth, gauze or bandage (8-10 folds), on top of which place a piece of cotton wool or twists of fabric. If the wound is located on the chest, then instead of cotton wool, apply a piece of any oilcloth (for example, a bag). If there is no package, then any piece of tissue should be coated with Vaseline, oil, fat-based ointment, etc., and placed on the chest wound. Wrap all this tightly to the body with any dressing material, for example, bandages, pieces of cloth or strips of torn clothing. If there is nothing to attach the bandage to the body, then you can simply glue it with tape, adhesive tape or medical glue;

22. If there are prolapsed organs on the abdominal wall, they are first covered around the perimeter with fabric rolls. Then these rollers are loosely tied to the body with any dressing material without squeezing the internal organs (see Figure 4). Such a bandage on the abdomen with prolapsed internal organs should be constantly watered with water to keep it moist;

Figure 4 – Applying a bandage for prolapsed organs abdominal cavity

23. After applying the bandage, you can apply cold (ice in a bag or water in a heating pad) to the wound area. If there is no cold, then there is no need to put anything on the wound (for example, snow or pieces of icicles in winter);

24. Place the victim on a flat surface (floor, bench, table, etc.). If the wound is below the heart, then elevate the victim's legs. If the wound is in the chest, then give the victim a semi-sitting position with legs bent at the knees;

25. Cover the injured person with blankets or clothing;

26. If blood has soaked the packing or dressing and is oozing out, do not remove it. On top of the blood-soaked bandage, simply apply another one;

27. If possible, an antibiotic should be administered intramuscularly. wide range actions (Ciprofloxacin, Amoxicillin, Tienam, Imipinem, etc.). If the wound is not in the stomach, then you can take antibiotic tablets;

28. While waiting for an ambulance or transporting a victim to the hospital by any other means of transport, it is necessary to maintain verbal contact with him if the person is conscious.

Algorithm for providing first aid to a victim with a bullet wound to the head

Gunshot wounds of the chest can be through and blind, tangential, tangential, segmental, diametrical and sliding. They may be accompanied by damage to the soft tissues and bones of the chest skeleton. More often, the bullet penetrates the chest cavity, damaging the pleura and lung. Such wounds are called penetrating wounds.

If a bullet encounters ribs, sternum or scapula in its path, it crushes them and can carry fragments deep into the soft tissues and lung.

Shrapnel and ricocheting bullets cause great destruction. Along with the bullet and shrapnel, particles of clothing, dirt from the surface of the skin, etc. get into the wound.
Gunshot injuries to the chest are severe and are accompanied by shock (pleuropulmonary shock).

Among the complications that are observed with gunshot wounds of the chest and lungs, pneumothorax should be noted.

Pneumothorax. Pneumothorax is the accumulation of air in the pleural cavity, where it enters through a damaged bronchus, lung or from the outside, through a chest wound, due to negative pressure in the pleural cavity and the suction action of the chest at the moment of inhalation. After entering the pleural cavity air lung subsides, and as a result, respiratory and circulatory disorders occur. In some cases mild completely switched off from the act of breathing.

The following types of pneumothorax are distinguished.

1. Open pneumothorax. Open pneumothorax is formed when there is a constant connection with the external environment through the bronchus, lung or chest wound. With an outwardly open pneumothorax, the wounded person develops severe general state with respiratory and circulatory disorders due to a collapsed lung, irritation nerve plexuses air entering the pleural cavity, displacement of the heart and oscillation of the mediastinum. With a small hole in the chest wall, air enters the pleural cavity with a characteristic whistle when inhaling and exhaling. Such wounds in the chest wall are called sucking. If the wound is not closed, the symptoms of shortness of breath will increase, the general condition of the wounded will worsen and death may occur.

2. Valvular pneumothorax. With valve pneumothorax, air from the lung freely enters the pleural cavity, and its return exit is hindered by the formed valve. In such cases, the pressure in the pleural cavity rises sharply, the heart and mediastinum are displaced, and in some cases large vessels become kinked. If help is not provided in a timely manner, the wounded person quickly dies. With pneumothorax with the formation of a valve, the wounded person experiences chest tightness, severe shortness of breath and a general loss of strength. The appearance of this type of pneumothorax often coincides with the onset of shock. When recognizing, attention is drawn to high tympanitis and the absence of respiratory sounds during auscultation.

3. Closed pneumothorax . If the wound in the lung is compressed, then an open pneumothorax can turn into a closed one. The wounded person's condition begins to gradually improve, shortness of breath stops, and cardiac activity gradually improves.

By breathing movements of the chest, air can be forced into the tissue between the tissues and into subcutaneous tissue, causing the so-called subcutaneous traumatic emphysema, with air sometimes penetrating far beyond the wound and chest. The face, torso, scrotum and limbs suddenly swell. As mentioned above, usually such emphysema does not pose a danger to the patient’s life; only in rare and most severe cases, when emphysema affects the mediastinum, death may occur due to circulatory and respiratory disorders.

Upon opening chest cavity shrapnel or bullet when the outside air is in large quantities immediately enters the pleural cavity and compresses the lungs, the resulting open pneumothorax is dangerous because infection is easily attached to it and pus appears in the pleural cavity: pyopneumothorax is formed, often ending in death.

When wounded chest wall may be damaged blood vessels, which may result in bleeding externally or into the pleural cavity. Blood that spills out when the vessels of the chest wall and lung are wounded into the pleural cavity forms an accumulation called hemothorax.

When the pulmonary vessels and bronchi are injured, bleeding may occur. Bleeding from the lung most often is not prolonged or significant due to the ability lung tissue subside. The bleeding usually stops on its own. A lung injury is accompanied by hemoptysis. Injury to vessels at the hilum of the lung is usually fatal.

When an infection enters the pleural cavity, pyothorax forms at the site of hemothorax and develops purulent inflammation pleura (empyema). In addition, when injured, ulcers can develop in the lung (and especially in places where foreign bodies are located - bullets and shrapnel). Gangrene of the lung in case of injury is rarely observed; inflammation of the lung is more common.

Symptoms of a gunshot wound to the lung. In the first time after injury, signs of acute anemia, difficulty breathing and poor circulation appear. In some cases, despite the apparent light picture wounds, the only symptom is hemoptysis. The direction of the wound channel (in case of penetrating wounds) may indicate a lung injury. For severe injuries skin pale, limbs become cold, lips turn blue, shortness of breath appears, painful cough, hemoptysis (pure blood mixed with air bubbles). The pulse is small, barely perceptible, irregular. Some of the wounded die from such phenomena; with a favorable course, all these disorders gradually disappear, but later the phenomenon of closed pyothorax may occur. On the 4-6th day, and sometimes later, the temperature quickly rises to 40°, and heavy sweats appear. If the wound is open, purulent fluid pours out of it. At closed wound the amount of fluid in the pleural cavity increases, the wounded half of the chest expands, the intercostal spaces smooth out, shortness of breath and cyanosis increase, the pulse becomes small and frequent, and delirium is observed. This indicates the transition of hemothorax to pyothorax.

Hemoptysis due to injury surface layers It may not be easy. All of these phenomena - shortness of breath, drop in pulse, signs of acute anemia - may be less pronounced.

X-ray examination may indicate the location foreign body(shards, bullets), and also determine the height of the fluid level in the pleura (hemothorax) and the presence of air.

Treatment . End-to-end gunshot wounds with a small entry and exit opening and the same blind wounds in the absence of increasing bleeding or pneumothorax, etc. should not be touched. For such wounds, it is necessary to smear the skin around the holes with iodine, apply a collodion bandage, then apply conservative measures and systematic punctures of the pleural cavity, sucking blood and exudate from its cavity and introducing penicillin into the pleural cavity. After helping a wounded person, he should be carefully monitored. A rapid increase in dullness, increased symptoms of organ displacement, increased shortness of breath, decreased and increased heart rate, increasing pallor, and a drop in temperature indicate ongoing bleeding; this may require surgical intervention(opening the pleural cavity), thoracotomy. To stop bleeding, it is recommended to do intravenous infusions of 5-10% calcium chloride(one should beware of tissue necrosis from the solution getting into the subcutaneous tissue). To stop bleeding, some people use a transfusion of 100-200 ml of blood (hemostatic dose).

For progressive pneumothorax, valve drainage is used. With hemothorax, especially accompanied high temperature, it is necessary to perform a puncture from the first days after injury to remove blood. For large wounds penetrating into the chest cavity with open pneumothorax, apply a hermetic bandage (ointment, wet) and provide surgical assistance at the nearest dressing station.

Produced in the hospital primary processing, refresh the edges lung wounds, ligate bleeding vessels, sometimes put a suture on lung wounds or sew in damaged lung area along the entire circumference of the chest opening, remove accumulated blood. The skin and muscles are sutured. When dirty better skin do not sew. If the hole is small and there is little bleeding, the wound is sutured (skin and muscle).

The victim is placed on his wounded side in a semi-sitting position, which makes breathing easier.

After surgery (especially on the lung), the wounded cannot be transported for approximately two weeks.

When turbid exudate accumulates in the pleural cavity or when pyothorax has already developed, systematic punctures are performed, fluid or pus is sucked out and 100,000-200,000 units of penicillin are injected into the pleural cavity. If such treatment is insufficiently effective, the pleural cavity is drained. Drainage is introduced through a small intercostal incision; rib resection is less commonly used. Good result achieved by treatment with constant aspiration. The drainage introduced into the pleural cavity is connected to a water jet or some other suction. Thanks to this, a constant negative pressure is created in the pleural cavity, which promotes constant suction of pus and straightening of the collapsed lung.

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 ✓ The article has been checked by a 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, it is necessary to urgently apply a 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 a victim to medical institution he should be given a half-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. A closed heart injury is also typical, with no open wound in the chest cavity.

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 the skin remains 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 injury is accompanied by an open pneumothorax, but may also occur 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. Affected areas lung tissue in this case, topographically correspond to the applied irradiation fields.

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 lung injuries.

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

Various unforeseen situations can happen in our lives. No one can be insured against an accident. Often, in case of accidents, falls from a height, domestic injuries, when engaging in combat sports, damage to the chest occurs.

This is a fairly broad group of injuries, which includes not only rib fractures, but also various damages internal organs. Often such injuries lead to significant blood loss, respiratory failure, which, in turn, may lead to serious complications health and even death.

All chest injuries can be divided into open and closed

Closed chest injuries

home distinctive feature- absence of wound. Let's look at the types of injuries and their clinical picture.

1. Rib fractures:

• Chest pain that gets worse with breathing;
• Cyanosis of the skin and mucous membranes;
• Cardiopalmus;
• The chest is deformed;
• Localization of pain at the fracture site;
• Pathological mobility and bone crepitus.

1. Chest concussion:

• Tachycardia, arrhythmia;
• Cyanosis;
• Frequent, shallow breathing;
• Changes in the depth and rhythm of breathing.

1. Hemothorax:

Symptoms often vary depending on the degree. Most common symptom any hemothorax - an increase in body temperature after a chest injury. Hypoxia and shortness of breath may also increase.

1. Pneumothorax:

• A sharp deterioration in general condition;
• Increased heart rate, increased shortness of breath;
• The skin is cold and cyanotic.

• Traumatic asphyxia.
• Increasing hoarseness of voice;
• Cyanosis of the upper half of the body;
• Swelling of the jugular veins;
• Increase in neck volume;
• Rapid development of cardiovascular failure.

1. Traumatic asphyxia.

• Sharp blueness of the skin, especially the nasolabial triangle;
• A bunch of pinpoint hemorrhages upper half of the body;
• Cough with bloody sputum;
• Hearing, vision, hoarseness.

Since vital energy is concentrated in the chest important organs, damage to which could lead to severe consequences, urgent Care the victims must be provided immediately.

Providing first aid for closed chest injury

• Place the victim in a semi-sitting position;
• Prohibit talking and breathing deeply;
• Carefully free the victim from constricting clothing (unbutton, cut);
• If the victim is unconscious, tilt his head back, slightly to one side;
• If the victim is conscious, take a painkiller (analgin, baralgin, etc.);
• Until the doctor arrives, do not leave the victim, monitor consciousness and pulse.

Open chest injuries

All open injuries chest are divided into: penetrating and non-penetrating.

Non-penetrating – usually applied with some object (knife, stick). The victim's condition is satisfactory, the skin is dry, there is slight cyanosis of the lips, no air suction is observed during inhalation, there is no cough or hemoptysis.

Such injuries do not pose a threat to life unless vital organs are damaged.

First aid for non-penetrating chest wounds

• Calm the victim;
• Call an ambulance;
• Apply a pressure bandage from any available material to the wound;
• Before the ambulance arrives, monitor the condition of the victim.

Penetrating – significantly worsen the condition of the victim. Appears:

• Severe chest pain;
• Shortness of breath, feeling of lack of air;
• The skin is pale, with a cyanotic tint, especially in the area of ​​the nasolabial triangle;
• Sticky, cold sweat;
• Fall progresses blood pressure, tachycardia increases;
• Both halves of the chest participate unevenly in the act of breathing;
• During inhalation, air is sucked into the wound;
• Foamy, bloody sputum and hemoptysis may appear.

Most often, penetrating chest injuries can be accompanied by injuries to such organs as:

• Lungs;
• Intercostal vessels;
• Heart;
• Diaphragm;
• Mediastinal vessels;
• Trachea, bronchi, esophagus;
• Abdominal organs.

Emergency first aid for penetrating chest wounds

MUST BE PROVIDED IMMEDIATELY!

1. Call an ambulance immediately;
2. Do not leave the victim a single step, calm him down, sit him in a semi-sitting position;
3. Prohibit deep breathing, talking, eating, drinking;
4. For the first time, after identifying the patient, the wound should be covered with your hand;
5. Next, they begin to apply an occlusive dressing from scrap materials. Before applying the bandage, the victim is asked to make a deep exhalation.

• The area adjacent to the wound is treated with a solution of skin antiseptic (iodine, chlorhexidine, brilliant green);
• The skin around the wound is lubricated with Vaseline or any greasy cream (if available);
• The first layer is any piece of clean bandage, gauze or any fabric so that the edges of the bandage are 4-5 cm from the edge of the wound; secure along the edge with adhesive tape.
• The second layer is any oilcloth, a bag folded several times. It is also secured with adhesive tape.
• Several rounds of bandage are made around the body from above.

1. If present in the wound foreign object Under no circumstances should you try to pull it out. It needs to be secured by covering the edges with napkins and securing with a bandage or adhesive plaster.
2. If the wound consists of 2 holes (entrance and exit), the bandage is applied to both wounds.
3. If help is provided to the victim after 40 - 50 minutes, then before the doctors arrive, the occlusive bandage is applied in the form of a U-shaped pocket, that is, it is attached only on 3 sides.

Any injuries to the chest are considered quite serious and dangerous injuries. Therefore, the correct, clear actions of the person who provides assistance to the victim will help preserve health and even life.