The main symptoms of multiple rib fractures
Traumatology / / May 11, 2016
When you save the consciousness of the victim to establish the fracture of several ribs usually presents no difficulty.Characteristic features of multiple rib fractures are the following symptoms: a sharp pain at the fracture site, aggravated by coughing and deep breathing, shallow rapid breathing and forced position of the victim, who is trying to provide peace of the damaged area of the chest wall.A very characteristic symptom of "ragged breaths" - when trying to breathe slowly and deeply suddenly there is a sharp pain, and the breath stops.The severity of patients with chest trauma, if there was no collateral damage internal organs, depends largely on the number of broken ribs and localization of fractures by "edge-ring."Pain and ventilation disorder is less pronounced in the posterior regions of fractures of ribs near the spine, due to the smaller displacement of bone fragments in the respiratory act as a result of anatomical features, and as a result a kind of immobilization at the position of th
Multiple fractures of the anterior and posterior parts of ribs are accompanied by pulmonary ventilation disorders, especially with the appearance of the paradoxical movement of the chest wall sections due to the formation of a "rib panels."The pathogenesis of the serious condition of patients with violation of "framing" of the chest plays a significant role inability to create a negative intrathoracic pressure necessary for a full breath.Disorders of ventilation enhanced reflex respiratory restriction of chest excursion due to the pain factor and the attendant injuries lung, development of hemo- and pneumothorax.Shock develops in each of the third with this kind of polytrauma.
Possible damage and complications of closed chest trauma
1 - aspiration of blood, mucus and vomit;
2 - obstruction, damage to the trachea;
3 - pneumothorax;
4 - rib fractures;
5 - a collapsed lung, bronchospasm;
6 - subcutaneous emphysema;
7 - floating ribs valve;
8 - hemothorax;
9 - spasm or paralysis of the chest muscles;
10 - ruptured spleen;
11 - kidney rupture;
12 - pneumoperitoneum, compression of large vessels;
13 - bleeding into the adrenal glands;
14 - liver a break;
15 - bronchopneumonia;
16 - embolism;
17 - obturation of the bronchi mucus, blood, the secret;
18 - gap bronchi and aorta;
19 - injury and pulmonary edema;
20 - hemopericardium;
21 - injury and cardiac rupture.
Diversity related injuries and complications of blunt chest trauma allows to make their overall visual scheme.The most frequent concomitant injury with multiple fractures of the ribs are damaged blood vessels of the chest wall: intercostal arteries and, less frequently, the internal thoracic artery.Damage to these vessels is the major cause of hemothorax and, as a consequence, severe anemia.When the fragments wounding sharp edges of the lung bleeding is usually abundant and has a tendency to self-termination.Hemothorax observed in 24.5% of the victims, out of which 79.1% it is combined with pneumothorax.Undoubtedly, hemothorax complicating chest trauma often, but accumulation of blood and effusions in small quantities (from 100 to 300 ml) is not detected by X-ray study.A pneumothorax occurs in 32.9% of the victims.Damage to internal organs of the chest detected in 71.7% of the victims, including lung damage - at 51.4%, the heart (bruises) - at 18.6%.
Damage lungs at multiple fractures often has the character of edge tears or bruises of different size portions, which clinically manifested pneumothorax, development of subcutaneous emphysema, pulmonary hemorrhage through the upper respiratory tract, hemoptysis, rapid breathing, the appearance acrocyanosis, pain in the chest.X-ray examination in the lungs can be seen multiple melkopyatnistye shadows, reflecting bleeding in lung tissue.Later, after 4-5 days, may reveal limited infiltration of the lung tissue in certain areas or throughout the lung fields, sometimes clinical picture of lung injury during fluoroscopy corresponds to the picture of pneumonia.In rare cases, local hematoma is formed, representing the well-known difficulties for the differential diagnosis of a lung tumor.
diaphragm damage clinically diagnose difficult, especially in severe multiple injuries.It is mandatory x-ray.The physical symptoms depend on the timing of the investigation after the injury, the presence of associated injuries, as well as the degree of prolapse of internal organs through the diaphragm rupture.Urging light up with limited mobility it can manifest itself in the development failure of the external breathing.Mediastinal shift in the opposite direction may lead to heart failure.As a general rule, at break of the left dome of the diaphragm into the pleural cavity bulging stomach and intestine, which is easily revealed by X-ray;in case of damage of the diaphragm to the right protrusion of the liver is not always detected.Diagnostics can help pneumoperitoneum in which the air moves through the rupture of the diaphragm from the abdominal cavity into the pleural.
Damage aortic affected clinically rare, because basically they are killed on the spot.Recent advances in thoracic surgery allows to hope for the possibility of salvation of the victims with timely diagnosis and surgery.A classic place aortic rupture in trauma chest is the area of its arc immediately after the discharge of the left subclavian artery.The clinical picture of aortic lesions is very characteristic.According to the mechanism of injury it can be expected by combining the spine and rib fractures, as well as impact or compression of the thorax in the anteroposterior direction with the formation of multiple fractures in the cartilaginous part of the ribs on the left.
Early symptoms: brief loss of consciousness, hypotension, dysphagia, hoarseness of voice (the pressure of the hematoma to the main bronchus, esophagus, and recurrent laryngeal nerve), systolic murmur in the aorta, the expansion of the shadow of the upper part of the mediastinum on chest radiograph.
mechanism heart injury often associated with compression of the chest or a strong direct blow to the sternum.As a result of a direct blow or injuries occur protivoudara infarction with hemorrhage, rupture of muscle fibers to break the epicardium and pericardium.Lesions usually are diffuse, at least - isolated (5: 1), the typical localization of them - the left ventricular wall.When a heart attack-like heart-shaped injury death can occur in the coming hours and days, regardless of other damage.Even with the favorable course of developing multiple sclerosis heart muscle disrupts the normal activity of the heart, greatly complicating the posttraumatic life of the victims.More favorable stenokardicheskie form of heart injury, are more likely to regress, however, and in this form of the disease process can progress with the outcome in chronic coronary insufficiency with the development of degenerative Cardiosclerosis.The clinical picture is characterized by persistent tachycardia, arrythmia, hypotension with a low pulse pressure, shortness of breath, cyanosis, moderate expansion of the boundaries of the relative cardiac dullness, easing tone I heart the appearance of pericardial friction noise, systolic murmur at the apex of the heart.An electrocardiogram reflects myocardial hypoxia, coronary insufficiency, typical of myocardial infarction.
Note that tachycardia is a diagnostic point of view is less informative than the aetiology - or rather, a symptom of the lack of a "normal" tachycardia typical polytrauma general.Mortality in "participation" bruised heart in polytrauma increased by 2-3 times.
- Multiple rib fractures
- Multiple fractures pelvis
- Multiple fractures of foot
- Multiple fractures of femur
- Multiple fractures of the tibia
- Multiple fractures ankle
- multiple fractures of the bones of the knee joint
- multiple fractures of the bones and the bones of one segment
- clinical picture of multiple fractures pelvis
- Combined treatment of injuries
- treatment of multiple rib fractures
injury organs of the upper abdomenand retroperitoneal with multiple fractures of the ribs almost natural, as these organs (liver, spleen, kidneys, adrenal glands) are located within the lower ribs, protected them and injured nearly as often as organs of the chest cavity.liver damage observed in 2.9% of victims (almost half of them die within the first 2 hours after the trauma of massive blood loss).Damage to the spleen is observed in 1.3% of the victims.With this injury, the spleen ruptures easily viewed and almost 30% of cases the diagnosis is established only at autopsy.Identification of damage internal organs of the abdomen can help procaine blockade of bone lesions.The possibility of "deep" abdominal palpation after blockade avoids abdominal injuries and avoid laparotomy.
kidney injury defined in 6.9% of patients.The most important symptom of kidney damage is hematuria (red blood cells and 20 in the field of view), which have suffered from kidney injuries lasts 2-3 days, when the capsule ruptures and cracks in the kidneys (50-60 red blood cells in the field of view) - for 7-9days.Urological research can be carried out in affected only after removing them from the shock.