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Damage to the skull, chest, abdomen and their bodies



Closed skull and brain damage.
Trauma skull soft tissues at its stream is not very different from other areas of damage. Differences occur when the brain is damaged. Allocate a concussion, compression of the brain, broken roof and base of the skull.
Concussion is developing under the influence of a considerable force on the skull as a result of being struck by an object or his injury during a fall. The essence of the changes taking place at the same time is gentle shake of brain tissue and the violation of histological cell interconnections.
Simptolsh and over. Loss of consciousness, evolving at the time of injury, - the main sign of a concussion. Depending on the severity of it may be short (a few minutes) or idazhesutok last several hours. Another important symptom is the so-called retrograde amnesia, which is expressed in the fact that the person regaining consciousness, does not remember what happened immediately before the injury.
Treatment:
First aid is to ensure peace and carrying out of actions, reduces swelling and brain swelling. Locally - cold, anti-anxiety, sleeping pills, diuretics.
All patients with a concussion should be hospitalized with the purpose of bed rest to them. With dramatically increased intracranial pressure, manifested severe headaches, vomiting, etc., To refine the diagnosis shows a puncture, which allows you to determine the pressure of the cerebrospinal fluid and blood in it content (what happens when the brain bruises and hemorrhages subarahpoidalpyh). Deleting when the puncture of 5-8 ml of cerebrospinal fluid usually improves the condition of the patient and it is completely harmless (see. Also Chap. Nervous Diseases).
brain contusion called a violation of the integrity of brain matter in a limited area. Usually at the point of application of force traumatic, but may also occur on the opposite side with respect to injury (injury from protivoudara).
Thus there is destruction of a part of the brain tissue of blood vessels, the histological cell bonds with the subsequent development of traumatic edema. Zone of violations varies and is determined by the severity of the injury. Observed cerebral phenomenon, the so-called contusion-kommotsionny syndrome: a. dizziness, headaches, vomiting, slow pulse, etc. Sometimes the temperature rise is attached to them. From concussion injury distinguish focal signs: loss of function of certain brain areas. So, it may be impaired sensitivity, movement, facial expressions, speech and others. These symptoms neurological examination allows the patient to deliver accurate topical diagnosis of the damaged area of ​​the brain.
Helping a bruise of the brain the same as that of concussion, but bed rest is observed duration.
Sdavlechie brain, intracranial bleeding. Compression of the brain is the result of the blood pressure on the brain when vnutrecherepnoe bleeding or bone fragments or fractures of the skull. Fragments of bone, compressing the substance of the brain, diagnosed with skull radiography, mandatory for cranial trauma. They are subject to surgical removal at craniotomy.
Much more difficult to recognize the compression of the brain, caused by intracranial hematoma (blood tumor). Hemorrhage in the cranial cavity of 30-40 ml in volume leads to increased pressure, compression of the brain and disruption of its functions. The accumulation of blood may be on the dura mater (epidural hematoma) under the dura mater (subdural hematoma) or within the brain (intracerebral hematoma).
Sshttomy and over. The typical condition for intracranial hemorrhage does not develop immediately after an injury, and after a few hours required for the accumulation of blood and compression of the brain tissue, and is called "light" gap. Symptoms of increased intracranial pressure: headache, nausea and vomiting, dizziness and loss of consciousness, hoarse, labored breathing, slow heartbeat, anisocoria (different size pupils, usually on the side of greater injury and tapering to light).
Violations of the movement and sensation in the extremities are found on the opposite side injury.
The clinic cord compression are three phases: initial, full development and paralytic. In phase 1 marked the initial signs of increased vnutrecherepnoe dvleniya and focal lesions. Full, bright, and the development of brain focal symptoms typical for the second phase. In the paralytic phase develops a coma, paralysis of the sphincter, extremities, frequent and small pulse, intermittent, wheezing, ending with cessation of breathing.
When compression of the brain shows the operation. The exact location in critically ill is sometimes difficult to determine; this requires, in addition to a thorough neurological examination, additional methods (ultrasonic echolocation, ventriculography v al.).
Closed injuries of the chest and its organs. Also concussions, bruises, compression of the chest wall, lung and heart, rib fractures, and others. Bones, there are closed fractures of the thoracic cavity. Usually posletravmy patients develop: a pronounced drop in cardiac activity, shortness of breath, paleness, cyanosis, cold shock appearance, and sometimes loss of consciousness.
If assistance is necessary to ensure the peace, appoint bed rest, warm, oxygen therapy and to spend money to enter the heart. Usually, after such treatment, all symptoms soon pass (if no bone fracture or organ damage).
Contusion of the chest may be accompanied by fractured ribs, rupture blood vessels of the chest wall, pleura and lung injury. The heart, as the body is anatomically more sheltered, damaged rare, even rarer damaged esophagus.
For fractures of the ribs and lung rupture can develop pneumothorax or hemothorax. The air that had accumulated in the pleural cavity, lung compresses and displaces the mediastinum in a healthy way. Disrupting the function of the heart and respiration, as it goes into the subcutaneous tissue, resulting in a subcutaneous emphysema. If the damage of intercostal and other vessels of the chest or razryvelegkogo arises bleeding into the pleural cavity is formed and hemothorax. Finally, severe injury can cause shock development.
Pneumothorax is called the accumulation of air in the pleural cavity. There are open, closed, and the valve pneumothorax. The accumulation of air in the pleura, which wound through the chest wall or the large bronchi in communication with the atmospheric air, is called an open pneumothorax. When closed pneumothorax air in the pleural cavity not communicated with the external environment.
When light breaks in the form of a flap valve may develop a pneumothorax, when you breathe in the air penetrates into the pleura, and during exhalation can not get out of the pleural cavity through the bronchus as easy flap closes damaged bronchi do not miss it. Thus, when the valve pneumothorax amount of air in the pleura with each breath and increases its pressure is increased, therefore it is another name tension pneumothorax.
Symptoms and over:
a small amount of air accumulation in the pleural usually does not cause disturbances and if it further flow is terminated, it dissolves. Significant accumulation of air, especially under pressure (valve pneumothorax), leads to compression of the lung, mediastinal shift, disrupting respiration and cardiac activity. open pneumothorax The danger is that when breathing air in and out of the pleura that infects the pleura and leads to the balloting mediastinum, nerve irritation and reduced respiratory surface of the lungs. This is manifested dyspnea, cyanosis, increased heart rate, restriction of respiratory excursion the patient side of the chest, the appearance of subcutaneous emphysema, boxed sound on percussion, and the weakening of respiratory noise. X-ray reveals the accumulation of air in the pleura and pulmonary atelectasis. Open pneumothorax complicated by shock more than 60% of patients.
Treatment:
Help with an open pneumothorax should be to impose hermetic (occlusive) dressings. Treatment operative. When the valve is shown pneumothorax puncture the chest wall marshy trocar to remove air. If odpomomentpoe removal of air from the pleural ineffective and he again builds up, then drain the pleura (the underwater drainage or constant aspiration), the operation shows the ineffectiveness of these methods.
The general condition of these patients is usually heavy, they need to rest, in the fight against anemia and restoring disturbed functions of vital organs.
Subcutaneous emphysema with chest trauma is the external expression of closed lung injury. She does not require the use of special therapeutic measures even at the highest degree of development. When you break the same easy operation is performed when indicated. air is usually soon absorbed from the subcutaneous tissue.
Hemothorax, ie accumulation of blood in the pleura, can be one-sided and two-sided. In the latter case there is a threat of death from asphyxiation. Unilateral small hemothorax does not cause severe disturbances and after a few days the blood is resorbed. Significant accumulation of blood in the pleura accompanied by development of severe anemia due to blood loss, respiratory failure (compression of the lung) and cardiac activity due to heart displacement. In these cases, shows repeated pleural puncture for blood extraction and subsequent administration of antibiotics.
When suction air nedolzhen penetrate the pleura, which is of great importance for the unfolding of the lung. For this purpose, the needle sleeve wear rubber tube that is clamped when removing the syringe, or use a cannula with a crane. In the absence of indications of emergency puncture start with 2-3 days after injury. punctures frequency is determined by the accumulation of blood in the pleural cavity.
Closed damage of the abdominal cavity. The most common injuries from closed abdominal and retroperitoneal ruptures occur hollow and parenchymal organs.
Bounce by an object in the stomach while relaxing the abdominal wall, or, conversely, when hitting the stomach, the lower part of the chest at the drop of a solid body is a typical mechanism of injury at break abdominal organs.
Power stroke, traumatic agent (hoof horse kick, wheel machines, falling objects, working part of the machine, a fall from a height on a rock, log, etc..) And the anatomical and physiological state of the body at the time of the damage is determined by the severity of the damage. A more extensive ruptures of hollow organs are, if they are in the moment of impact were filled. Slept intestinal loops and stomach rupture is rare. Breaks parenchymal organs, altered pathological process (malarial spleen, liver with hepatitis and others.) May be at a lower injury.
When you break a hollow body (intestine, stomach, etc.), The main danger is the infection of the abdominal cavity and its contents and the development of diffuse peritonitis. Breaks parenchymal organs (liver, spleen, kidneys) risk of developing internal bleeding and severe anemia. In these patients may rapidly develop purulent peritonitis due to the presence of infection (at rupture of the liver, kidney, bladder) and nutrient medium - blood.
Symptoms and over:
Clinic closed organ damage zhivotaharakterizuetsya the emergence of severe pain around the abdomen with the greatest severity in the area of ​​the damaged organ. The sharp tension of the muscles of the abdominal wall, giving the feeling on palpation doskoobraznoy density, a characteristic symptom of rupture intra-abdominal organs.
the patient's general condition is severe: paleness, cold sweats, frequent and small pulse, a tense stillness in the supine position, with hips typically given to the stomach, the picture of shock or acute anemia, depending on the damaged organ.
Parenchymal organ damage, accompanied by internal bleeding, quickly leads to the development of severe anemia: increasing paleness, frequent and small pulse, dizziness, vomiting, progressive reduction in blood pressure and so on. When percussion abdomen marked dullness in the lower side of its departments, moved by change of position. Sometimes vnutribryushpom bleeding to the development of the abdominal wall infections can be mild tense, but as a rule, there is swelling and pronounced symptoms of peritoneal irritation. The rapid development of peritonitis characteristic of rupture of hollow organs.
abdominal X-rays for suspected rupture of a hollow organ helps clarify the diagnosis, because Unable to determine free gas in it.
Treatment:
abdominal organ injuries require immediate surgery, which is due to the difficult condition of the patient is performed under the supervision of blood pressure, pulse, respiration and blood transfusion is accompanied by struynokapelnym.
When intraperitoneal rupture of the kidney when the blood and urine coming into the abdominal cavity, is shown emergency surgery laparotomy, which, depending on the severity of kidney failure can result in its removal or suturing wounds with kidney insulated from abdominal and lumbar drainage through an additional incision.
Extraperitoneal breaks kidneys accompanied by the development of a large retroperitoneal hematoma, swelling of the lumbar region, the release of urine from the blood, and the development of varying degrees of acute anemia. If there is no severe acute anemia, these patients are treated conservatively: calm, cold pas loin, the introduction of hemostatic agents, blood transfusion hemostatic doses. To prevent festering hematoma it is aspirated and injected antibiotics.
If anemia is growing, needs surgery. Exposure of the affected kidney (via lumbar incision) and depending on the severity of the injury - its removal or closure of brine followed by drainage. If necessary, the removal of a kidney surgeon must verify the presence of the patient's second kidney functioning.
Vputribryushinny bladder rupture is accompanied by cessation of urination, and rapid development of peritonitis, severe intoxication. It is shown that immediate surgery to suture the wounds of the bladder and to ensure the flow of urine.
Extraperitoneal bladder rupture appears formation of a large infiltration of the pubis, reaching the navel, lack of urination and severe intoxication due to absorption of urine.
Treatment - Emergency operation consisting in an exposure of the bladder (without opening the peritoneum), suturing his injuries and to ensure the flow of urine. Sometimes it is acceptable to provide a permanent urinary diversion catheter inserted through the urethra.
In patients with damage to cells or a group of belly sleduetuchityvat always the possibility of so-called torakoabdomipalnyh damage (one-stage breast and abdomen).
Injuries to the abdomen may be accompanied by a rupture of the diaphragm and the entry of the viscera into the chest cavity. At the turn of the ribs on the right is always necessary to consider the possibility of rupture of the liver and to investigate the victim in the direction of detection of the damage; damage to the ribs on the left is often accompanied by rupture of the spleen.






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