Lung rupture, consequences, causes of damage. The mechanism of development of the clinical picture and the factors causing it

Penetrating wounds of the chest are inflicted with cold and firearms. There are also industrial and household open damage.

Penetrating wounds of the chest are divided into wounds without open pneumothorax, with open pneumothorax. In addition, bullet and shrapnel wounds are distinguished, which can be blind and through.

Pathological data

Penetrating stab wounds of the chest are characterized by smooth walls of the wound channel and usually small bone lesions. With these injuries, large blood vessels are often damaged. The severity and subsequent course of the injury depends on the damage to the lung. Injuries to the root of the lung, where large vessels and bronchi pass, are usually fatal; such wounded people soon die from severe intrapleural bleeding. Injuries to the middle layer of the lung are also dangerous due to large blood losses. Only with damage to the surface layer of the lung, bleeding can be moderate and relatively quickly stop on its own.

With gunshot wounds, the skin damage is often small. But the destruction of deep tissues (subcutaneous tissue, muscles, fascia, bones) is more significant.

Fragments of damaged ribs or scapula are carried away by the wounding projectile and themselves become instruments of destruction, tearing intercostal vessels and the lung. Damage to the lung can be different: sometimes a narrow wound channel in the lung is filled with blood clots, sometimes extensive ruptures and crushing of the lung occur with the presence of large pieces of tissue doomed to necrosis.

With penetrating wounds (usually gunshot wounds), pleural empyema (total and limited) often develops. In a relatively long period after injury, the formation of broncho-pleural or broncho-cutaneous fistulas is possible.

Penetrating chest wounds without open pneumothorax

The presence of a closed pneumothorax is often found with penetrating wounds. When the wound edges are glued, the flow of air stops and a closed pneumothorax occurs.

Symptoms of wounds without open pneumothorax vary greatly depending on the severity of the injury, the presence of shock, and the severity of intrapleural bleeding. Sometimes the victim feels so good that he does not even agree to go to bed. In other cases, on the contrary, he soon falls into a serious condition.

With a small hemothorax, small accumulations of air, the patient's condition usually remains satisfactory. In the first days there is a cough and a moderate increase in temperature.

Wounded with significant destruction of the lung and large hemothorax are often in serious condition. They complain of pain, dizziness, severe shortness of breath and cough. Their skin is pale, their face and lips are bluish. The pulse is frequent, weak filling. Blood pressure is reduced. Severe shortness of breath is noticeable. With a change in body position and the slightest physical effort, shortness of breath increases even more and the patient suffers heavily from pain and a feeling of suffocation.

With hemorrhage into the pleural cavity, it is noted, which is especially pronounced with significant intrapleural bleeding. On physical examination, dullness is determined according to the accumulation of fluid. Breathing is not audible here. Voice tremors are absent or weakened. The heart is displaced, and this displacement is more significant the more it is.

The displaced lung is compressed and airless, therefore, only weakened breathing with a bronchial tint is heard above the liquid level.

The spilled blood is an irritant of the pleura, so already in the first days of injury there is a combination of hemothorax and pleurisy (hemopleuritis). In the absence of infection, the spilled blood is gradually absorbed, which has a beneficial effect on the general condition of the wounded.

When hemothorax resolves, extensive adhesions and moorings sometimes form. As a result, the mobility of the ribs and diaphragm decreases, which reduces the respiratory function of the lung. Often adhesions fix the pericardium and mediastinal pleura, sometimes complicating the activity of the heart.

Penetrating chest wounds with open pneumothorax

With an open pneumothorax, a free communication of the pleural cavity with the atmosphere is established. The pleura and lung are an extensive receptor zone, irritation of which in open pneumothorax leads reflexively to breathing disorders and cardiac activity.

Open gives a sharp decrease in the depth of breathing - up to 200 cm3 instead of 550-600 cm3, which depends on the collapse of the lung, displacement of the mediastinal organs, which is not only pushed to the healthy side, but also moves during breathing (balloting, or floating, of the mediastinum). With open pneumothorax, paradoxical breathing occurs.

Open pneumothorax causes significant disturbances in external respiration, changes hemodynamics, leads to hypoxemia and serves as a source of reflex irritation of brain centers important for life.

Penetrating chest injuries with open pneumothorax are the most severe injuries to the chest.

Many injuries result in death in a very short time. Those wounded who manage to be taken to hospitals are often in traumatic shock.

With penetrating gunshot wounds, in 90% of cases the lung is damaged and only in 10% the wounding projectile passes through the reserve space of the pleura, bypassing the lung tissue. In addition, 79% of the wounded have damage to the ribs, less often there are injuries to the sternum, scapula, and collarbone.

Most of the wounded with open pneumothorax, even in the absence of severe lung damage, die if they do not receive surgical care.

Such wounded people are restless and suffer from severe pain, painful coughing and shortness of breath. The victim finds no relief from the feeling of tightness in the chest and severe suffocation, which intensify with the slightest physical exertion.

When examining such a wounded person, one notices pallor, cold sweat, and cyanosis. Breathing is rapid and sometimes reaches 40 respiratory movements per minute. In most cases, the pulse is weak. Blood pressure is reduced.

Air passes through the wound into the chest cavity. When you cough, blood and bubbles are sometimes expelled from the wound. With defects in the chest wall, it is possible to see the parietal pleura or the edge of the lung. However, with narrow wounds of the chest, the presence of an open pneumothorax is often difficult to detect during external examination.

The clinical course of penetrating chest wounds with pneumothorax is severe. In case of refusal or even untimely surgical treatment of the wound, belated closure of it with sutures, purulent pleurisy inevitably develops, clouding the prognosis.

Diagnosis of wounds

When diagnosing penetrating wounds of the chest, it is necessary to find out the nature of the injury - whether it is penetrating or non-penetrating. The presence of pneumothorax, hemothorax undoubtedly indicates the penetrating nature of the injury.

When assessing the nature of penetrating gunshot wounds, the direction of the wound channel is important, and when examining blind wounds, the presence of foreign bodies is important. Of course, this criterion alone is not enough to resolve the issue regarding the degree of damage to the lung, but in combination with other signs, it gives an approximate idea of ​​\u200b\u200bpossible destruction during the passage of a wounding projectile.

X-ray examination plays an important role in the diagnosis of lung injuries. The extent of bone destruction is most accurately revealed by radiography. Pneumothorax and hemothorax are also accurately determined radiographically. Lung hemorrhages and foreign bodies can be detected mainly by radiography. Finally, fluoroscopy and radiography make it possible to accurately and objectively note the dynamics of changes in the lung and pleural cavity (disappearance of pneumothorax, resolution of hemorrhages in the lung, decrease or increase in fluid).

Pleural puncture can detect changes in the transparency and color of the pleural fluid, as well as obtain material for bacteriological culture.

When studying pleural punctures, it is established that in cases uncomplicated by infection, the shed blood initially approaches the blood circulating in the bloodstream in terms of hemoglobin content and leukocyte formula. Then the percentage of hemoglobin decreases and by the 10th day after injury reaches 15-20 or even less. With uninfected hemothorax, the leukocyte count in some cases shows an increase in leukocytes, and in others - eosinophils. Infection of hemothorax is manifested by hemolysis, an increase in the percentage of neutrophils in the leukocyte formula.

Resolving the issue of the penetrating nature of the wound is sometimes very difficult. We are talking about wounded people who initially do not experience pneumothorax or hemothorax. As clinical experience shows, in these cases, even with primary surgical treatment, it is not possible to find a defect in the pleura and the wound is considered non-penetrating. However, in the next few days, with a repeated X-ray examination, it is possible to determine an insignificant amount of air and prove the penetrating nature of the wound where it was denied even when the wound canal was opened and its edges were excised.

Treatment of penetrating chest wounds

Until recently, conservative trends prevailed in the treatment of penetrating wounds.

Currently, the urgent tasks of treating penetrating chest wounds are to stop fatal bleeding, restore normal breathing, and cardiac activity. At the same time as solving these urgent problems, it is necessary to take measures to prevent wound infection.

The choice of treatment methods is dictated by the characteristics of the injury. With modern surgical capabilities, the following principles for the treatment of penetrating wounds can be outlined.

In case of knife or gunshot wounds of large vessels of the chest wall (a. intercostalis, a. mammaria int. a. subclavia), where there is rapidly increasing intrapleural bleeding and a mortal threat to the victim, immediate surgical treatment is required. In providing assistance to these wounded, mistakes are often made, since, following the tactics of conservative treatment of hemothorax, they are content with suctioning the blood and prescribing hemostatic agents. However, such treatment, which is quite appropriate for hemothorax caused by damage to the peripheral parts of the lung, turns out to be untenable for intrapleural bleeding due to injury to the mentioned arteries of the chest wall. The experience of peacetime surgery shows that in case of damage to the intercostal arteries, the mortal threat of intrapleural bleeding should not be stopped even before a wide thoracotomy in order to ligate the damaged vessels, which bleed especially heavily if they are ruptured in the posterior sections near their origin from the aorta.

If the intrathoracic artery is injured, sufficient surgical access should be provided. For this purpose, it is necessary to resect the costal cartilages closest to the wound site and, if necessary, bite the edge of the sternum with Luer forceps. With this approach it is difficult to avoid opening the pleura. If the pleural cavity is accidentally or intentionally opened, you should insert a finger into it and press the artery from the inside to the sternum or costal cartilage, after which all further manipulations to expand surgical access proceed calmly. Further, opening the pleural cavity allows for an inspection of the organs (lungs, pericardium), which is extremely important for deciding the volume of surgical assistance.

In case of injuries to the subclavian artery or vein with damage to the adjacent pleura and intrapleural bleeding, there is a need for resection of the clavicle and dissection of the tissues of the subclavian space to provide the necessary access to bleeding large vessels.

Intrapleural use is mandatory for any wound, especially gunshot wounds.

If the root of the lung is injured with damage to the large blood vessels located here, emergency surgery is indicated. With conservative treatment, such wounded people die from intrapleural bleeding.

Surgical assistance consists of a wide opening of the pleural cavity and ligation of damaged vessels. Since the patient’s condition in such cases is usually serious, it is difficult to decide on a more radical treatment than ligation of the bleeding vessels in order to provide emergency care. Of course, if the wounded person’s condition allows, then the non-viable part of the lung should be removed.

After stopping the bleeding, you need to suture the wound, suck out the air from the pleural cavity, if possible, achieving straightening of the lung.

It is left underwater for 1-2 days for the outflow of blood and pleural exudate, as well as for the introduction of antibiotics into the pleural cavity.

If, with a penetrating wound of the chest without an open pneumothorax, there is no rapidly increasing intrapleural bleeding, then the issue of treatment is resolved differently.

Even with gunshot wounds, which have the most unfavorable course, patients with a penetrating chest wound without an open pneumothorax often do not require surgical treatment. We are talking about victims who had minor wounds and minimal bone damage. Indeed, with small wounds of the chest, there is no point in cutting the tissue and turning a closed pneumothorax into an open one, which gives a more severe clinical course. In case of severe destruction of the tissues of the chest wall, on the contrary, careful treatment of the wound with resection of crushed ribs is necessary. In this case, it is possible to open the pleural cavity.

In some wounded patients, revision of the pleural cavity may be necessary. Indications for revision are severe intrapleural bleeding, suspicion of significant destruction of the lung and the known presence of foreign bodies.

Treatment of penetrating chest wounds with open pneumothorax is difficult. First aid is important - immediately covering the wound with a bandage that prevents the free flow of air. As first aid, the patient is injected with morphine under the skin and a vagosympathetic blockade is performed.
In a medical institution, if a wounded person has severe, life-threatening bleeding, they begin immediately, carrying out anti-shock measures, including (mandatorily) blood transfusions.

The most important goal of surgery for wounds with open pneumothorax is to close the wound and eliminate the gap in the pleural cavity. To achieve this, the wound is excised, removing non-viable soft tissue and removing bone fragments (ribs, shoulder blades) that have lost contact with the periosteum. Often it is necessary to resort to resection of broken ribs.

When the chest wall wound is treated, you need to examine the pleural cavity and remove any foreign bodies that have entered. Incised lung wounds should be closed with single catgut sutures. If part of the lung is crushed from a gunshot wound, removal of the destroyed tissue (marginal resection of the lung, lobectomy) is indicated, of course, if the general condition of the wounded person allows it.

In many cases of knife and gunshot wounds, there is only minor damage to the lung tissue, and the bleeding has already stopped by the time of the operation, so there are no indications for intervention on the lung. In such wounded people, it is necessary to close the wound tightly after careful surgical treatment.

For large defects of the ribs and intercostal muscles, rapprochement of the wound edges after PSO is not possible, so it is advisable to cut out a flap from nearby muscles and sew it into the defect.

Surgical treatment of transscapular wounds requires special attention. Fracture of the scapula and ribs, as well as damage to the muscles located here, make it necessary to provide sufficient access to the posterior parts of the pleura. For this purpose, damaged and non-viable muscles have to be excised, and the broken part of the scapula removed, exposing the destroyed ribs covered by it. Covering the defect of the chest wall after resection of the ribs is carried out by displacing and fixing adjacent muscles or by cutting out and moving a muscle flap.

In case of penetrating wounds of the chest with a closed pneumothorax, as well as after surgical treatment and suturing of wounds, transformation of an open pneumothorax into a closed one, it is necessary to pay the most serious attention to the early and possibly most complete removal of blood and exudate from the pleural cavity, achieving straightening of the lung and contact of the pleural layers .

Strict clinical monitoring of the patient and radiological monitoring are required. The accumulation of exudate usually indicates the beginning of an infectious process in the pleura. In the presence of cloudy pleural exudate, and especially with positive bacteriological cultures, intrapleural administration of antibiotics is required. When microbes are detected in pleural exudate, it is advisable to choose the most active drug, which is easily determined by the microbiological disk method. The use of antibiotics according to a pattern, without proper bacteriological control, leads to the introduction of a drug that is ineffective for a given microorganism (or association of microbes), and sometimes causes the formation of forms of microbes resistant to it.

The article was prepared and edited by: surgeon

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 cruel joke, and even with the Criminal Code at hand, it is not possible for a person who is far from the code of criminal laws of the country to determine the possible punishment, as well as assess the need to immediately seek qualified legal assistance.

Types of bodily injury

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

The legislation classifies injuries as follows:

• lungs;
• moderate severity;
• heavy.

Since 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 is assigned by law to such a category of professionals as a forensic medical expert who is an employee of a medical institution or has permission to conduct special research and perform 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 a significant loss of ability to work in a ratio of less than one third of the general 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 alcohol abuse. At the same time, recognition of a knife through an examination with cold steel is not a necessary condition for criminal liability to occur.

Depending on the attitude of the accused person to the crime he has committed, the act is classified as attempted murder or causing varying degrees of harm.

Most often, liability for this type of attack on human life and health occurs under the following articles:

1. Causing grave damage (Article 111 of the Criminal Code of the Russian Federation).
2. Causing moderate 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 injuries and the possible consequences of their infliction on 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, wounding a person in the abdominal cavity, even if it is not accompanied by profuse bleeding, can be fatal if vital internal organs are affected. At the same time, without a special examination by a qualified specialist of the victim, it is impossible to determine which organs are affected and what consequences this will lead to.

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

Procedure for filing a police report

Legislatively, the procedure for filing an application 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. The oral form implies the mandatory entry of data into the protocol from the words of the applicant, and in the absence of such an opportunity, the report of a law enforcement official. Verbal statements are also called crime reports. In both forms, a prerequisite for acceptance is the presence of the applicant's installation data.

Anonymous messages are not considered as grounds for initiating a criminal case. Applications are subject to mandatory registration in accordance with the procedure established by law. The maximum term for their consideration for making a legal decision is a period of 30 days.

The result of a review by a law enforcement agency may be:

1. Criminal proceedings.
2. Issuance of a decision to refuse to initiate 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 duty of the doctor providing medical assistance to the victim to notify the competent authorities of all "criminal" injuries: gunshot wounds, stab wounds, beatings, and so on.

Accordingly, having no intention to declare an offense that has occurred, it will not be possible to avoid communicating with law enforcement officers about the nature of the injuries received. At the same time, in order to initiate a criminal case on the fact of causing serious or moderate bodily harm, the presence of a statement from the victim is not required.

Proceedings on these crimes are conducted in a public order, 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.

If a knife wound is classified as a serious or moderate crime, criminal proceedings will be continued upon the fact that the person received severe or moderate bodily injuries, regardless of the wishes of the victim.

In the event of an influential person being involved in a criminal trial as an accused, or possessing certain material wealth. 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 court.

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 (the Prosecutor General's Office or territorial representative office).

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 recourse to qualified legal assistance;
• involvement of an independent expert in the forensic medical examination;
• performing at the pre-trial stage all necessary actions that 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 terminate the legal proceedings will not be enough, no matter in what form it occurs. It is worth noting that the state of alcoholic intoxication will be accepted by the court as an aggravating circumstance.

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Worst Best

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

Pathological anatomy. With stab wounds, damage to the lung tissue is mainly limited to the zone of the wound canal; with 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 in 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 of the lung and chest wall, i.e. traumatic hemothorax and blood loss; the entry of blood into the airways with the occurrence of aspiration atelectasis.

Clinic. Signs of lung damage due to 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 of respiratory failure, symptoms of blood loss with significant intrapleural or intrabronchial bleeding.

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

Treatment has the main task of eliminating pneumo- and hemothorax and completely straightening the damaged lung. In the absence of accumulation of gas and blood in the pleural cavity and significant damage to the chest wall, it can be purely symptomatic. With minor, spontaneously sealed lung damage and minor hemo- and pneumothorax, a sealed puncture of the pleural cavity is sufficient to evacuate air and blood. If pleural exudate subsequently accumulates (traumatic pleurisy), the puncture with evacuation of fluid and administration of antibacterial agents is performed again. 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 constant active aspiration. This measure ensures expansion of the lung 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 respiratory tract; 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; the formation of a massive blood clot in the pleural cavity (“coagulated hemothorax”), which cannot be melted and aspirated when using local therapy with fibrinolytics; large foreign bodies in the lung. The intervention consists of surgical debridement of the chest wall wound, thoracotomy under intubation anesthesia, hemostasis, and suturing of the lung tissue wound. 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 rare cases, the forehead - or even pneumonectomy.

Classification. There are closed and open lung injuries.

Closed lung injuries: 1. Lung contusion. 2. lung rupture. 3. crushed lung. Ruptures of the lung are single and multiple, and in shape - linear, polygonal, patchwork.

There are open injuries (wounds) of the lung: stab wounds and gunshot wounds.

A.V. Melnikov and B.E. Linberg distinguish three zones of the lung: dangerous, threatened, safe.

The danger zone is the root of the lung and the hilar area, where large vessels and bronchi of the 1st and 2nd order pass. Damage to this area is accompanied by profuse bleeding and tension pneumothorax.

The threatened zone is the central part of the lung. Segmental bronchi and vessels pass through here.

The safe zone is the so-called cloak of the lung. Includes the peripheral part of the lung, where small vessels and bronchioles pass.

Lung contusion

Lung contusion is damage to lung tissue while maintaining the integrity of the visceral pleura. Pulmonary contusions are divided into limited extensive.

Pathanatomy: in the area of ​​the bruise there is hemorrhagic penetration of the lung parenchyma without sharp boundaries, destruction of the interalveolar septa. There may be destruction of lung tissue, bronchi, and blood vessels with the formation of a cavity filled with air and blood in the lung. With a bruised lung, atelectasis, pneumonia, and an air cyst of the lung develop.

The clinic depends on the size of the area of ​​damage to the lung.

With limited bruises of the lungs, the victim’s condition is satisfactory, less often – moderate. There are pains at the site of injury, shortness of breath, cough, hemoptysis. BP is not changed, the pulse is somewhat rapid. On auscultation, there is a weakening of respiratory sounds over the site of the injury with the presence of moist rales. Percussion sound dull. On a survey radiograph: in the pulmonary field, an oval or spherical darkened area with indistinct, blurry contours is visible.

With extensive bruises of the lung, the patient's condition is moderate or severe. The victims are admitted in a state of shock and severe respiratory failure with shortness of breath up to 40 breaths per minute, cyanosis of the facial skin, blood pressure is reduced, and tachycardia reaches high numbers. Auscultation of breathing on the injured side is sharply weakened, with moist rales.

Diagnostics. 1. Clinic. 2. Survey fluoroscopy (graphy) of the chest. 3. Tomography. 4. Bronchoscopy. 5. Computed tomography.

Treatment: 1. Relief of pain syndrome (novocaine blockades, analgesics). 2. Antibacterial therapy. 3. Vascular therapy. 4. Restoration of normal drainage function of the bronchi. 5. Breathing exercises. 6. Physiotherapy.

Clinically and radiologically, lung contusions occur in 2 scenarios: 1. With adequate conservative treatment, the process is completely stopped after 10 days.

2. The so-called post-traumatic pneumonia, which can be treated conservatively within 10-14 days or a lung abscess develops.

Wounds and ruptures of the lung

Lung injuries in which lung tissue and visceral pleura are damaged. Blood and air enter the pleural cavity.

Characteristic signs of lung damage: 1. Pneumothorax. 2. Subcutaneous emphysema. 3. Hemothorax. 4. Hemoptysis.

All victims with closed lung injuries are divided into the following groups:

1. with pneumothorax; 2. with valvular pneumothorax; 3. with hemothorax.

For open lung injuries, another group is added - with open pneumothorax.

Clinic: 1. General symptoms of damage. 2. Specific symptoms.

Common symptoms include: pain, signs of bleeding, shock, respiratory failure. Specific symptoms include: pneumothorax, hemothorax, subcutaneous emphysema, hemoptysis.

Diagnostics: 1.Clinic. 2. Plain radiography (scopy) of the chest. 3. Ultrasound of the chest. 4. Pleural puncture. 5. thoracoscopy 6. Pho wound.

Treatment: The general principles of treatment depend on the type and severity of the rupture or injury of the lung. They include: elimination of pain, early and complete drainage of the pleural cavity for the purpose of rapid expansion of the lung, effective maintenance of airway patency, sealing of the chest wall for open injuries, antimicrobial and supportive therapy.

If the lung is damaged with an open pneumothorax, first of all, the wound is pierced, the open pneumothorax is sutured and the pleural cavity is drained. The vacuum mode during aspiration for gluing the edges of a lung wound is 15-20 cm of water column.

If the lung is damaged with a small hemothorax, a puncture of the pleural cavity is performed and blood is removed from the sinus. For moderate hemothorax, drainage of the pleural cavity with blood reinfusion is indicated.

Indications for thoracotomy for lung injuries:

1. Profuse intrapleural bleeding. 2. Continued intrapleural bleeding - if 300 ml of blood per hour or more is released through the drainage, with a positive Ruvilois-Gregoire test. 3. Intractable conservative tension pneumothorax.

Operative access for lung injury is lateral thoracotomy in the 5-6 intercostal space.

Operational tactics: For superficial wounds or damage to the peripheral zone of the lung, interrupted sutures are applied. For this, thin silk, nylon or lavsan threads are used.

For deep wounds of the lung: the wound channel is inspected, with the removal of blood clots and foreign bodies. If necessary, the lung tissue is dissected above the wound channel. During the revision, damaged vessels and small bronchi are sutured and bandaged. Particular care is taken to inspect wounds at the root of the lung. A deep lung wound must be sutured tightly, without leaving dead spaces. To achieve this, the wound is sutured to its full depth with one thread or several rows of sutures. For stitching, a round, large, steeply curved needle is used.

With extensive destruction of the edge of the lung, wedge-shaped atypical resection is indicated. The lung, within the healthy tissue, is sutured twice with a UKL device.

If lung tissue is crushed within one or more segments, resection of one or more segments is performed. In case of massive destruction of lung tissue within one lobe, a lobectomy is performed. If the entire lung is destroyed or its root is damaged, a pneumonectomy is indicated.

After the intervention on the lung is completed, the pleural cavity is freed from blood clots and pleural drainage is installed according to Bulau. Before suturing a thoracotomy wound, it is necessary to ensure that the lung or its remaining part is fully expanded.

Damage to the trachea and bronchi.

Classification: distinguish between closed and open injuries of the trachea and bronchi.

Depending on the depth of damage, there are incomplete (damage to the mucous membrane or cartilage) and complete (penetrating into the lumen). Complete ruptures can occur with separation of the ends of the bronchi and without separation. Damage to the bronchi is extremely rarely isolated. More often, the lungs, mediastinum, and large vessels are simultaneously damaged. Damage to the trachea occurs due to knife and gunshot wounds to the neck.

Clinic: depends on the location and extent of damage.

Characteristic signs: 1. Emphysema of the mediastinum. 2. Subcutaneous emphysema. 3. Hemoptysis. 4. Tension pneumothorax. 5. Wound on the neck, communicating with the trachea.

With all types of damage to the trachea and bronchi, ventilation disturbances occur with severe respiratory failure. Sometimes asphyxia develops.

With open injuries to the trachea, air mixed with blood whistles out of the neck wound.

With combined injuries of the trachea and bronchi, signs of shock, blood loss, and respiratory failure come to the fore.

Diagnostics: 1. Clinic. 2. Plain radiography of the chest. The main radiological signs of bronchial damage are: mediastinal emphysema, pneumothorax, pulmonary atelectasis, subcutaneous emphysema. 3. Bronchoscopy. 4. thoracoscopy 5. computed tomography. It is imperative to examine the esophagus. Indirect signs of bronchial damage are: excessive release of air through the pleural drainage, ineffective drainage of the pleural cavity, collapse of the lobe or lung against the background of pleural drainage, increasing mediastinal emphysema.

Treatment: The main task of the preoperative period is to ensure and maintain airway patency. For mediastinal emphysema, a cervical mediastinotomy is performed. In case of tension pneumothorax, pleural drainage is installed in the 2nd intercostal space. If damage to the bronchus or thoracic trachea is suspected or a diagnosis of bronchial damage has been established, an urgent thoracotomy is indicated. The most convenient is the lateral approach. In case of isolated damage to the thoracic trachea, a longitudinal or longitudinal-transverse sternotomy is performed.

ABOUT

operative tactics: There are the following types of operations for damage to the bronchi: 1. suturing the wound defect; 2. excision of the edges of the defect, wedge-shaped or circular resection with restoration of lumen patency; 3. end-to-end anastomosis when the bronchus is separated; 4. lobectomy or pneumonectomy.

Indications for suturing are small wounds and defects. For lacerated and bruised wounds, the edges of the wound are excised to restore bronchial patency. Indications for pneumonectomy: significant destruction of lung tissue, inability to restore bronchial patency, damage to the vessels of the lung root.

Such damage is closed, and can be caused by impact, squeezing or shaking. In the most severe degrees of the disease, blood vessels and bronchi may be damaged. Hemorrhages appear very often.

There are cases when a lung contusion causes the formation of cavities filled with air or blood. In this case, the membrane itself covering the lungs is not damaged at all.

Lung contusion: symptoms

The very first sign that patients focus on is severe pain in the lung area. When you take a deep breath, this pain intensifies many times over. Extremely unpleasant sensations can appear when bending over or in any other position of the body.

If bloody expectoration is noticed, then a lung contusion is possible. Symptoms that are not as common are tachycardia and bluish skin.

If the injuries were severe, the injured person may experience rapid breathing and shock. Very often the body lacks oxygen.

Bleeding, bruising, and swelling are often noticeable on the outside of the chest.

A lung contusion may not be immediately detected. Especially if the ribs are also damaged. Therefore, the patient may not even understand the extent of the damage.

Cases of pneumonia due to lung injury have been reported. It can be either focal or lobar.

Causes of injury

According to medical information, severe pulmonary contusion is a consequence of closed chest injuries. This injury can occur by falling from a very high height or hitting the steering wheel of a car during a traffic accident. Explosions and knife wounds cannot be ruled out. Usually, along with a contusion of the lungs, the heart, ribs and the chest itself also suffer.

Diagnostics

A lung contusion can be diagnosed in several ways:

1) During a superficial inspection. This procedure involves examining the chest. If hemorrhage is noticed on it, the lungs may be injured.

2) Using ultrasound. If there is a damaged area, an echo-positive shadow will appear on the screen.

3) A severe contusion of the lung can be determined while listening to the organ. This can be done by simply leaning your ear or using a stethoscope.

4) Using an x-ray, a bruise can be identified due to polymorphic darkening of the lung in the injured area.

5) Examination of the lungs using a bronchoscope. It is a hollow tube with a light source at the end. Thus, swelling of the bronchi or accumulations of blood can be seen.

Urgent Care

If the victim is diagnosed with a lung contusion at first glance, treatment should be provided immediately. First aid will help relieve pain, minimize consequences and relieve symptoms.

To do this, apply a cold compress to the bruised area. You can use a frozen bottle or ice pack for this purpose. Apply this compress periodically for a few minutes.

There is no need to keep the compress on for too long. This can cause frostbite on the skin or colds.

Provide the victim with complete rest. It is advisable to place it in a horizontal position and ensure that the patient moves as little as possible. For the first time after an injury, it is best to keep the injured person in a semi-sitting position. Before the doctor arrives, you should not use any medications. This can only make things worse.

Pneumothorax

During a chest injury, the patient may experience two serious conditions. These include pneumothorax and hemothorax.

A lung contusion (symptoms and treatment are determined during diagnosis) is a rather complex injury that requires urgent attention from a specialist.

Pneumothorax is the accumulation of air in the pleural area. Such a lesion most often occurs with stab wounds to the chest or during trauma to the chest. With a complex degree of the disease, a wound occurs into which a large amount of air enters. In this case, the damaged part of the lung becomes inoperable. The most difficult case is considered to be: Air enters, but cannot come out. Thus, with each breath, the pressure in the cavity increases.

This condition can cause severe shock. Without urgent surgery, the victim may die.

If a person has an open wound in the chest, then first of all you need to seal it with improvised means. You can use a bag, oilcloth or film. Secure the sides with bandages, plaster or tape and wait for the ambulance to arrive.

Of course, such extreme measures are not strong, but they can save a person’s life before the doctors arrive. If possible, blood-absorbing materials should be placed in front of the airtight ones. Fabric is suitable for this.

Already in a hospital setting the following treatment is carried out:

The chest is made airtight again and the disease is transferred to a closed form.

An electric vacuum is used to suck out the air bubble from the pleura.

The pressure returns to normal due to drainage of the cavity.

Carrying out puncture of the cavity with air.

Hemothorax

This condition is characterized by hemorrhage in the pleural cavity. This phenomenon can cause a serious threat to human life.

If the size of the hematoma is too large, then the injured lung begins to compress the healthy one. That is, an injury to even one lung will disable both. A symptom of such injury is frequent but shallow breathing and sometimes loss of consciousness.

In extreme conditions, with an open wound, the patient needs to put a blood-absorbent bandage and seal the wound. If the wound is closed, a cold compress is ideal. It will narrow the blood vessels, and the amount of blood released will be much less.

In a hospital setting, the clotted blood in the cavity is drained and the lung is released.

Treatment of bruise

A lung contusion (symptoms and consequences are discussed by us) must be treated immediately. At home, this can be a cold compress.

If the injury is minor, then complete rest and painkillers will be enough. Pain and shortness of breath may be present for a few days before subsiding.

For more severe bruises, anti-inflammatory treatment is prescribed. Antibiotics are often used to prevent pneumonia.

The bronchoscopy procedure is prescribed to suck out excess fluid from the lung cavity. A few days after the injury, physiotherapeutic procedures are prescribed to speed up the healing process.

Please note that in the next few days after injury, do not apply heat to the damaged area. It will only increase swelling and inflammation.

Preventing complications

To avoid complications and strengthen the respiratory system, experts have developed a set of special breathing exercises. Such exercises should be performed when the treatment of the disease is nearing completion. Walking in the fresh air has a good effect. This is especially true for walks in a coniferous forest. Find an opportunity and go to such a place for a few days.

Consequences of a lung contusion

Whatever the degree of injury, it cannot be ignored, since the consequences of the disease can be extremely dangerous. The most common complication of a common lung contusion is this. This disease is very dangerous and quite often leads to death.

To prevent this from happening, urgently go to the hospital and get diagnosed. Timely medical assistance will be the key to a future happy life. Most often, with proper medical care, any complications can be avoided.