Damage to the skull, chest, abdomen and their organs
Closed damage to the skull and brain.
Injury of the soft tissues of the skull in its course is almost not different from damage to other areas. Differences appear in brain damage. There is concussion, compression of the brain, fractures of the fornix and base of the skull.
A concussion develops when a significant force acts on a skull as a result of hitting it with an object or bruising it during a fall. The essence of the changes occurring in this case is the shaking of the delicate brain tissue and the violation of the histological relationships of the cells.
Symptoms and course. Loss of consciousness that develops at the time of the injury is the main sign of concussion. Depending on the severity, it may be short-term (within a few minutes) or it may last for several hours and then the rest. The second important symptom is the so-called retrograde amnesia, expressed in the fact that a person, having regained consciousness, does not remember what happened immediately before the trauma.
Treatment:The provision of first aid consists in providing rest and carrying out activities that reduce swelling and brain swelling. Locally - cold, soothing, hypnotic, diuretic.
All patients with concussion should be hospitalized with bed rest. With a sharply increased intracranial pressure, manifested by severe headaches, vomiting, etc., to clarify the diagnosis, a puncture is shown that allows you to determine the pressure of the cerebrospinal fluid and blood content in it (which happens with brain injuries and subarachaloid hemorrhages). Removal of 5–8 ml of cerebrospinal fluid during puncture usually improves the patient’s condition and is completely harmless (see also Chap. Nervous diseases).
Brain injury is a violation of the integrity of the medulla in a limited area. Usually it happens at the point of application of the traumatic force, but it can also be observed on the side opposite to the injury (injury from a counter-impact).
When this occurs, the destruction of part of the brain tissue of the blood vessels, histological connections of cells with the subsequent development of traumatic edema. The area of such violations is different and is determined by the severity of the injury. Observed cerebral phenomena, so-called. contusion-commutation syndrome: dizziness, headaches, vomiting, slow pulse, etc. Sometimes they are accompanied by fever. Focal signs distinguish a brain contusion from concussion: loss of function of one or another brain area. Thus, sensitivity, movements, facial expressions, speech, etc. may be impaired. According to these symptoms, a neurological examination of a patient allows for accurate topical diagnostics of the damaged brain area.
Helping with brain contusion is the same as with concussion, but bed rest is observed for longer.
Brain scaling, intracranial bleeding. The compression of the brain is the result of pressure on the brain of the blood during intracranial bleeding or bone fragments or fractures of the skull. Fragments of the bone, which squeeze the substance of the brain, are diagnosed by radiography of the skull, mandatory for cranial trauma. They are subject to surgical removal during craniotomy.
It is much more difficult to recognize brain compression caused by intracranial hematoma (blood tumor). Hemorrhage into the cranial cavity with a volume of 30-40 ml leads to an increase in pressure, compression of the brain and disruption of its functions. The accumulation of blood can be above the dura mater (epidural hematoma), under the dura mater (subdural hematoma) or inside the brain (intracerebral hematoma).
Ststomy and flow. The characteristic condition with intracranial bleeding does not develop immediately after the injury, but after a few hours, which is necessary for the accumulation of blood and compression of the brain tissue, and is called the "light" gap. Symptoms with increased intracranial pressure: headache, nausea and vomiting, dizziness and loss of consciousness, hoarse, intermittent breathing, slow pulse, anisocoria (different sizes of pupils, usually on the side of the injury wider and not narrowed in the light).
Violations of movement and sensitivity in the limbs are found on the side opposite the injury.
In the clinic of brain compression, there are three phases: initial, full development and paralytic. In phase 1, initial signs of an increase in intracranial dysfunction and focal lesions are noted. Complete, bright development of cerebral and focal symptoms is typical for the second phase. In the paralytic phase, a coma develops, paralysis of the sphincters, limbs, rapid and small pulse, intermittent, hoarse breathing, resulting in the cessation of breathing.
At a brain compression operation is shown. The exact localization in seriously ill patients is sometimes difficult to determine; this requires, in addition to a thorough neurological examination, additional methods (ultrasound echolocation, ventriculography, etc.).
Closed damage to the chest and its organs. In addition to concussions, bruises, compression of the chest wall, lungs and heart, rib fractures and other bones, there are closed ruptures of the chest cavity organs. Usually after injuries in patients develop: a pronounced drop in cardiac activity, shortness of breath, pallor, cyanosis, cold shock, and sometimes loss of consciousness.
When providing care, it is necessary to provide rest, assign bed rest, warming, carry out oxygen therapy and inject heart remedies. Usually, after such treatment, all the symptoms disappear soon (if there are no bone fractures or organ damage).
Bruising of the chest can be accompanied by a fracture of the ribs, rupture of the blood vessels of the chest wall, injury to the pleura and lung. The heart, as an organ more anatomically covered, is rarely damaged, the esophagus is damaged even less often.
With rib fractures and lung ruptures, pneumothorax or hemothorax may develop. The air accumulated in the pleural cavity squeezes the lung and shifts the mediastinum in a healthy direction. Violating the function of the heart and respiration, it also goes into the subcutaneous tissue, resulting in subcutaneous emphysema. When damage to the intercostal and other vessels of the chest or ruptured light, bleeding into the pleural cavity occurs and hemothorax is formed. Finally, a severe bruise can cause the development of shock.
Pneumothorax is the accumulation of air in the pleural cavity. Distinguish between open, closed and valve pneumothorax. The accumulation of air in the pleura, which through the wound of the chest wall or through the large bronchus communicates with atmospheric air, is called open pneumothorax. With a closed pneumothorax, the air in the pleural cavity does not communicate with the external environment.
When a lung ruptures in the form of a flap, valve valvular pneumothorax may develop, when air inhales into the pleura when inhaled, and when exhaling it cannot escape from the pleural cavity through the bronchus, since the lung flap closes the damaged bronchi does not let it through. Thus, with valvular pneumothorax, the amount of air in the pleura increases with each inhalation and its pressure increases, so it is also called the intense pneumothorax.
Symptoms and course:The accumulation of air in the pleura in a small amount usually does not cause disturbances and if its further flow stops, then it dissolves. Significant accumulation of air, especially under pressure (valvular pneumothorax), leads to compression of the lung, displacement of the mediastinum, disturbing breathing and cardiac activity. The danger of open pneumothorax is that when breathing air enters and leaves the pleura, which infects the pleura and leads to a running of the mediastinum, irritation of the nerve endings and a decrease in the respiratory surface of the lungs. This manifests severe shortness of breath, cyanosis, increased heart rate, restriction of respiratory excursions of the sore side of the chest, the appearance of subcutaneous emphysema, boxed sound during percussion and the weakening of respiratory noise. Radiographically detected air accumulation in the pleura and lung atelectasis. Open pneumothorax is complicated by shock in more than 60% of patients.
Treatment:The help at open pheumothorax has to consist in imposing a hermetic (occlusive) bandage. Treatment is prompt. With valvular pneumothorax, the puncture of the chest wall is indicated by ancillary trocar to remove air. If the single-stage removal of air from the pleura is inefficient and it accumulates again, then the pleura is drained (underwater drainage or constant aspiration), if these methods fail, an operation is indicated.
The general condition of such patients is usually severe, they need rest, in the fight against anemia and in the restoration of impaired functions of vital organs.
Subcutaneous emphysema in chest injury is an external expression of a closed lung injury. She herself does not require the use of special therapeutic measures, even with strong degrees of development. At a rupture of the lung according to indications, an operation is performed. From the subcutaneous tissue air is usually soon absorbed.
Hemothorax, i.e. accumulation of blood in the pleura, can be unilateral and bilateral. In the latter case, the threat of death from asphyxiation. The unilateral small hemothorax does not cause severe disturbances and after a few days the blood is resorbed. Significant accumulation of blood in the pleura is accompanied by the development of acute anemia due to blood loss, respiratory failure (compression of the lung) and cardiac activity due to the displacement of the heart. In these cases, repeated punctures of the pleura for suction of blood and subsequent administration of antibiotics are shown.
When suctioning air should not penetrate into the pleura, which is of great importance for smoothing the lung. To do this, the needles are put on the coupling by a rubber tube, which is pressed when the syringe is removed, or a cannula with a tap is used. In the absence of emergency indications, puncture starts from 2-3 days after the injury. The frequency of puncture is determined by the accumulation of blood in the pleural cavity.
Closed damage to the abdominal cavity. The most common of the closed injuries of the abdominal cavity and retroperitoneal space are ruptures of hollow and parenchymal organs.
A strong blow to any object on the stomach while relaxing the abdominal wall or, on the contrary, when you strike with the stomach, the lower part of the chest when falling on a solid body is a typical mechanism of injury when the organs of the abdomen rupture.
The force of the impact, the traumatic agent (the horse’s hoof, the wheel of the machine, the falling object, the part of the machine running, when falling from a height on a stone, a log, etc.) and the anatomical and physiological state of the organ at the time of injury are determined by the severity of the damage. More extensive ruptures of hollow organs are if they were filled at the moment of impact. Collapsed intestinal loops and stomach rarely break. Disruptions of parenchymal organs, modified by the pathological process (malarial spleen, liver in hepatitis, etc.) can be with less trauma.
At rupture of a hollow organ (intestine, stomach, etc.), the main danger is infection of the abdominal cavity by its contents and the development of diffuse purulent peritonitis. Ruptures of parenchymal organs (liver, spleen, kidneys) are dangerous due to the development of internal bleeding and acute anemia. In these patients, purulent peritonitis can rapidly develop due to the presence of an infection (at rupture of the liver, kidneys, bladder) and the nutrient medium - blood.
Symptoms and course:The clinic of closed injuries of organs of the abdomen is characterized by the appearance of severe pain throughout the abdomen with the greatest severity in the area of the damaged organ. The sharp tension of the muscles of the abdominal wall, on palpation, giving a sensation of a base-like density, is a characteristic symptom of ruptures of the intra-abdominal organs.
The general condition of the patient is severe: pallor, cold sweat, frequent and small pulse, intense immobility in the prone position, usually with the hips brought to the stomach, a picture of shock or acute anemia depending on the damaged organ.
Damage to the parenchymal organ, accompanied by internal bleeding, quickly leads to the development of acute anemia: increasing pallor, frequent and small pulse, dizziness, vomiting, progressive reduction in blood pressure, and so on. With the percussion of the abdomen, there is a blunting in the lower lateral parts of the abdomen, moving with a change of position. Sometimes, when intraperitoneal bleeding occurs before the infection develops, the abdominal wall may be mildly tense, but, as a rule, there is swelling and a pronounced symptom of peritoneal irritation. The rapid development of peritonitis is characteristic of the rupture of hollow organs.
Radiography of the abdominal cavity in case of suspected rupture of a hollow organ helps to clarify the diagnosis, because manages to determine free gas in it.
Treatment:Damage to the organs of the abdomen require immediate surgery, which due to the serious condition of the patient is performed under the supervision of blood pressure, pulse, breathing and is accompanied by blood transfusions with a jet-droplet method.
When intraperitoneal rupture of the kidney, when blood and urine enters the abdominal cavity, an emergency operation of the chest cavity is indicated, which, depending on the severity of destruction of the kidney, may result in its removal or wound closure with isolation of the kidney from the abdominal cavity and drainage through an additional lumbar incision.
Extraperitoneal kidney ruptures are accompanied by the development of a large retroperitoneal hematoma, swelling of the lumbar region, the release of urine with blood and the development of varying degrees of acute anemia. If there is no severe acute anemia, these patients are treated conservatively: rest, cold on the lower back, the introduction of hemostatic drugs, the transfusion of hemostatic blood doses. For the prevention of suppuration, hematomas suck it off and inject antibiotics.
If anemia increases, surgery is necessary. Exposure of the damaged kidney (through the lumbar incision) and, depending on the severity of the injury, its removal or suturing of the brine with subsequent drainage. If it is necessary to remove the kidney, the surgeon must ensure that the patient has a second functioning kidney.
The intraperitoneal rupture of the bladder is accompanied by cessation of urination and the rapid development of peritonitis, severe intoxication. Immediate surgery is shown to suture a bladder wound and ensure urine flow.
Extraperitoneal rupture of the bladder is manifested by the formation of a large infiltration above the pubis, reaching the navel, lack of urination and severe intoxication as a result of the absorption of urine.
Treatment is an emergency surgery consisting in exposing the bladder (without opening the peritoneum), suturing its injuries and ensuring urine outflow. Sometimes it is permissible to provide urine diversion with a permanent catheter inserted through the urethra.
In victims with damage to a group of cells or the abdomen, the possibility of so-called thoraco-abdominal injuries (one-time breast and abdomen) should always be taken into account.
Abdominal injuries may be accompanied by a rupture of the diaphragm and the entry of the viscera into the chest cavity. When the right ribs fracture, you should always consider the possibility of a rupture of the liver and examine the victim in the direction of identifying this damage; damage to the left ribs is often accompanied by rupture of the spleen.
Infectious diseases for all
Diseases of the ear, nose and throat
Modern research methods