Injury. Open and closed injuries. Injuries of soft tissues, head, chest, abdomen. (lecture 7).pdf
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About This Presentation
Injury. Open and closed injuries. Injuries of soft tissues, head, chest, abdomen.
Slide Content
Injuries of soft tissues, head, chest, abdomen.
Thepresentationusesitsownmaterials
and materials from open sources
(Internet).
Department ofGeneral Surgery
withcoursesoftransplantology
andradiationdiagnosticsofIAPE,
GarayevMaratRailevich,Ufa,2022
Thepresentationusesitsownmaterials
and materials from open sources
(Internet).
Department ofGeneral Surgery
withcoursesoftransplantology
andradiationdiagnosticsofIAPE,
GarayevMaratRailevich,Ufa,2022
INJURY
Injury(damage) -is the effect of environmental factors (mechanical, physical,
chemical, etc.) on tissues, organs or the body as a whole, leading to anatomical
and physiological changes, accompanied by a local and general reaction of the
body.
Damage, depending on the application of force, is divided into direct and indirect.
Injuries are:
isolated -with damage to one anatomical and functional formation of the
musculoskeletal system;
multiple -with damage to two or more anatomical and functional formations or
damage to blood vessels and nerves in various segments of the limbs;
combined -damage to internal organs in various cavities with trauma to the
musculoskeletal system
combined -the simultaneous presence of two etiologically heterogeneous injuries
in the victim (for example, a fracture of the humerus and body burns).
Injuries are the cause of 8-10% of all deaths and are the third leading cause
of death in the Russian Federation.
Injury(damage) -is the effect of environmental factors (mechanical, physical,
chemical, etc.) on tissues, organs or the body as a whole, leading to anatomical
and physiological changes, accompanied by a local and general reaction of the
body.
Damage, depending on the application of force, is divided into direct and indirect.
Injuries are:
isolated -with damage to one anatomical and functional formation of the
musculoskeletal system;
multiple -with damage to two or more anatomical and functional formations or
damage to blood vessels and nerves in various segments of the limbs;
combined -damage to internal organs in various cavities with trauma to the
musculoskeletal system
combined -the simultaneous presence of two etiologically heterogeneous injuries
in the victim (for example, a fracture of the humerus and body burns).
Injuries are the cause of 8-10% of all deaths and are the third leading cause
of death in the Russian Federation.
1.The World Health Organization (WHO) has developed the
International Classification of External Causes of
Injuries (ICECI). According to this system, injuries are
classified according to:
1.Mechanism of injury;
2.Objects / substances that caused injury;
3.Areas of the body / organ where the injury occurred;
4.Human activity during traumatization;
5.Roles of human intention (intentional, unintentional, etc.).
Classifications
International Classification of External Causes of
Injuries (ICECI). According to this system, injuries are
classified according to:
1.Mechanism of injury;
2.Objects / substances that caused injury;
3.Areas of the body / organ where the injury occurred;
4.Human activity during traumatization;
5.Roles of human intention (intentional, unintentional, etc.).
Classifications
2. By the nature of
damage to the integrity
of the skin:
1. Closed -without
violating the integrity of
the skin and mucous
membranes (closed
trauma to the abdomen,
head, chest, etc.);
2. Open (wounds) -in case
of violation of the integrity
of the skin and mucous
membranes (knife and
gunshot wounds, open
bone fractures, etc.). With
open injuries, there is a
risk of infection.
Classifications
damage to the integrity
of the skin:
1. Closed -without
violating the integrity of
the skin and mucous
membranes (closed
trauma to the abdomen,
head, chest, etc.);
2. Open (wounds) -in case
of violation of the integrity
of the skin and mucous
membranes (knife and
gunshot wounds, open
bone fractures, etc.). With
open injuries, there is a
risk of infection.
Classifications
3. By the nature of
penetration into the
body cavity (with
open injuries in the
projection of the
cavities):
1. Non-penetrating -
without penetration of a
traumatic agent into the
body cavity (abdominal,
pleural, etc.);
2. Penetrating -the
traumatic substance
penetrates into the body
cavity, while there is a
risk of damage to
internal organs.
Classifications
penetration into the
body cavity (with
open injuries in the
projection of the
cavities):
1. Non-penetrating -
without penetration of a
traumatic agent into the
body cavity (abdominal,
pleural, etc.);
2. Penetrating -the
traumatic substance
penetrates into the body
cavity, while there is a
risk of damage to
internal organs.
Classifications
3. Anatomical classification:
1. Injuries of soft tissues;
2. Injuries of bones and joints;
3. Trauma to internal organs.
Classifications
1. Injuries of soft tissues;
2. Injuries of bones and joints;
3. Trauma to internal organs.
Classifications
Classifications of closed soft tissue
injuries:
•сoncussion
•сontusion(bruise),
•stretching,
•tear/rupture,
•compression.
Open injuries of soft tissues -wounds (to
be discussed in a separate lecture).
injuries:
•сoncussion
•сontusion(bruise),
•stretching,
•tear/rupture,
•compression.
Open injuries of soft tissues -wounds (to
be discussed in a separate lecture).
A concussion -is a closed tissue injury without a
macroscopic violation of their integrity, but with a short-
term dysfunction. Pain is characteristic, less often -slight
swelling in the damaged area, which, as a rule, passes on its
own. This diagnosis is most often applied to the brain, and
in relation to soft tissues it is almost never made.
Vibration that regularly affects soft tissues can lead to the so-called
vibration disease (for example, during prolonged work with a
jackhammer, on a machine tool) -this is discussed in the course of
occupational diseases.
macroscopic violation of their integrity, but with a short-
term dysfunction. Pain is characteristic, less often -slight
swelling in the damaged area, which, as a rule, passes on its
own. This diagnosis is most often applied to the brain, and
in relation to soft tissues it is almost never made.
Vibration that regularly affects soft tissues can lead to the so-called
vibration disease (for example, during prolonged work with a
jackhammer, on a machine tool) -this is discussed in the course of
occupational diseases.
А сontusion(bruise) is a closed injury to soft tissues and
organs without violating their anatomical integrity, but with a
longer dysfunction. A bruise occurs when struck with a blunt
object, falling from a height, collision from a body blow with a
blunt object, from an air wave, etc.
Clinical picture: Locally, swelling, hemorrhage, and soreness
are observed.
Treatment: First aid -cool the area of injury (apply ice).
Later, after the exclusion of injuries of bones and joints, they
provide physical rest for several days, apply topical ointments
with anticoagulants, physiotherapy.
organs without violating their anatomical integrity, but with a
longer dysfunction. A bruise occurs when struck with a blunt
object, falling from a height, collision from a body blow with a
blunt object, from an air wave, etc.
Clinical picture: Locally, swelling, hemorrhage, and soreness
are observed.
Treatment: First aid -cool the area of injury (apply ice).
Later, after the exclusion of injuries of bones and joints, they
provide physical rest for several days, apply topical ointments
with anticoagulants, physiotherapy.
Stretching is a closed injury, which is a tear of the fibers of the
ligament (muscle) due to its excessive tension in two mutually
opposite directions. At the same time, the general anatomical
continuity of the tissues is preserved. The most common places
for sprains are the ankle, knee, or wrist joints.
Clinical picture: Locally observed pain, aggravated by
movement, increasing swelling, limited mobility in the joint.
Treatment: First aid -cool the injured area (apply ice),
immobilize, elevate the injured area. Later, after excluding
injuries of bones and joints, they provide physical rest for several
weeks, apply local ointments with NSAIDs, and physiotherapy.
ligament (muscle) due to its excessive tension in two mutually
opposite directions. At the same time, the general anatomical
continuity of the tissues is preserved. The most common places
for sprains are the ankle, knee, or wrist joints.
Clinical picture: Locally observed pain, aggravated by
movement, increasing swelling, limited mobility in the joint.
Treatment: First aid -cool the injured area (apply ice),
immobilize, elevate the injured area. Later, after excluding
injuries of bones and joints, they provide physical rest for several
weeks, apply local ointments with NSAIDs, and physiotherapy.
A rupture is a complete or partial (tear) violation of the integrity
of a ligament or (less often) a muscle as a result of its excessive
tension in two mutually opposite directions by a force exceeding the
strength of the ligament (muscle). Most often occurs when playing
sports or performing heavy physical work. Ligament ruptures in the
ankle joint often occur when the leg is twisted while walking.
Clinical picture: There is a sharp pain, rapidly increasing swelling,
there may be hemorrhage, the impossibility of certain movements.
With complete ruptures, excessive mobility in the joint is
sometimes observed. Sometimes you can see a retraction in the
area of muscle rupture with a thickening of the limb above and
below the site of retraction.
of a ligament or (less often) a muscle as a result of its excessive
tension in two mutually opposite directions by a force exceeding the
strength of the ligament (muscle). Most often occurs when playing
sports or performing heavy physical work. Ligament ruptures in the
ankle joint often occur when the leg is twisted while walking.
Clinical picture: There is a sharp pain, rapidly increasing swelling,
there may be hemorrhage, the impossibility of certain movements.
With complete ruptures, excessive mobility in the joint is
sometimes observed. Sometimes you can see a retraction in the
area of muscle rupture with a thickening of the limb above and
below the site of retraction.
The diagnosis is made on the basis of clinical symptoms, x-ray
data, ultrasound, CT and MRI.
data, ultrasound, CT and MRI.
An example of diagnosing a tendon rupture
using ultrasound
(A)Comparison of both posterior ankles in a patient with a right posterior
Achilles tendon rupture.
(B)Longitudinal ultrasound image of the area of pain in the back of the
right ankle, noting the retracted ends of the Achilles tendon (arrows)
and the hematoma between them (*).
using ultrasound
(A)Comparison of both posterior ankles in a patient with a right posterior
Achilles tendon rupture.
(B)Longitudinal ultrasound image of the area of pain in the back of the
right ankle, noting the retracted ends of the Achilles tendon (arrows)
and the hematoma between them (*).
Treatmentis most often surgical -restoration of integrity
surgically. Less often (with tears) -conservative (prolonged
immobilization).
surgically. Less often (with tears) -conservative (prolonged
immobilization).
Compression is a prolonged compression of tissue by a traumatic
agent. Non-intensive and short-term compressions proceed without
clinical manifestations. If a circulatory disorder develops in the
compressed tissues, then skin necrosis and the formation of
bedsores occur.
Treatment: decompression of the compressed area, treatment
with antiseptics (in case of skin damage); long dressings until the
wound is cleansed and scarred. Less commonly, surgical treatment
-excision of necrosis, plastyof a wound defect by skin plasty.
agent. Non-intensive and short-term compressions proceed without
clinical manifestations. If a circulatory disorder develops in the
compressed tissues, then skin necrosis and the formation of
bedsores occur.
Treatment: decompression of the compressed area, treatment
with antiseptics (in case of skin damage); long dressings until the
wound is cleansed and scarred. Less commonly, surgical treatment
-excision of necrosis, plastyof a wound defect by skin plasty.
Syndrome ofprolonged tissuecompression (synonyms:
traumatictoxicosis,crushsyndrome,etc.).
Ithas2maindevelopmentmechanisms:
1.withalongforcedposition(forexample:thepatientfellasleep
whilesquatting,oftenobservedinpersonsinastateof
alcoholicordrugintoxication)-thisistheso-calledpositional
ischemia,whichdevelopsasaresultofcompressionofthe
mainvessels,leadingtoischemiaandtissuedeath;
2.withprolongedcompression andsubsequent release
(decompression)ofthecompressedpartofthebodyfromthe
squeezingagent(duringlandslides,earthquakes,accidents).
traumatictoxicosis,crushsyndrome,etc.).
Ithas2maindevelopmentmechanisms:
1.withalongforcedposition(forexample:thepatientfellasleep
whilesquatting,oftenobservedinpersonsinastateof
alcoholicordrugintoxication)-thisistheso-calledpositional
ischemia,whichdevelopsasaresultofcompressionofthe
mainvessels,leadingtoischemiaandtissuedeath;
2.withprolongedcompression andsubsequent release
(decompression)ofthecompressedpartofthebodyfromthe
squeezingagent(duringlandslides,earthquakes,accidents).
The clinical picture of the syndrome of prolonged
compression (crash syndrome) can be divided into 4
stages:
1)Early stage (or period of imaginary well -being). In the first hours
after decompression, the general condition of the patient is
satisfactory. The patient notes pain in the injured limb, weakness,
nausea. The limb is pale, sometimes covered with bluish spots, skin
sensitivity is impaired.
2) Stage of traumatic shock -
develops 36 hours after
decompression. The patient develops
anxiety, fear, euphoria, which are
replaced by apathy, drowsiness.
Tachycardia develops, blood pressure
drops. Increased swelling of the
extremities. Due to the release of the
liquid part of the blood into the tissue,
its thickening develops. Locally in the
limb, traumatic edema causes
compression of tissues and blood
vessels, which in turn exacerbates
tissue ischemia.
compression (crash syndrome) can be divided into 4
stages:
1)Early stage (or period of imaginary well -being). In the first hours
after decompression, the general condition of the patient is
satisfactory. The patient notes pain in the injured limb, weakness,
nausea. The limb is pale, sometimes covered with bluish spots, skin
sensitivity is impaired.
2) Stage of traumatic shock -
develops 36 hours after
decompression. The patient develops
anxiety, fear, euphoria, which are
replaced by apathy, drowsiness.
Tachycardia develops, blood pressure
drops. Increased swelling of the
extremities. Due to the release of the
liquid part of the blood into the tissue,
its thickening develops. Locally in the
limb, traumatic edema causes
compression of tissues and blood
vessels, which in turn exacerbates
tissue ischemia.
The clinical picture of the syndrome of prolonged
compression (crash syndrome) can be divided into 4
stages:
3) Stage of traumatic toxicosis-develops 1-2 days after
decompression. Myoglobin, lactic acid, tissue breakdown products
accumulate in the blood. Acidosis, myoglobinuriadevelops (myoglobin is
excreted by the kidneys, and since it is a coarse protein, it accumulates in
the renal tubules and disrupts urine filtration). Oliguria develops, then
anuria, which leads to the accumulation of decay products and
nitrogenous slags in the blood, uremia develops, that is, acute renal
failure (ARF) develops.Under these conditions, a large load falls on
another detoxification organ -the liver. It is not able to neutralize such a
concentration of toxic substances, and acute liver failure develops,
jaundice appears. Body temperature rises, intoxication and multiple organ
failure develop.
4) Stage of outcome. The progression of renal and hepatic insufficiency
leads to the death of the patient. If it is possible to restore the function of
the liver and kidneys, then the patient gradually recovers.
compression (crash syndrome) can be divided into 4
stages:
3) Stage of traumatic toxicosis-develops 1-2 days after
decompression. Myoglobin, lactic acid, tissue breakdown products
accumulate in the blood. Acidosis, myoglobinuriadevelops (myoglobin is
excreted by the kidneys, and since it is a coarse protein, it accumulates in
the renal tubules and disrupts urine filtration). Oliguria develops, then
anuria, which leads to the accumulation of decay products and
nitrogenous slags in the blood, uremia develops, that is, acute renal
failure (ARF) develops.Under these conditions, a large load falls on
another detoxification organ -the liver. It is not able to neutralize such a
concentration of toxic substances, and acute liver failure develops,
jaundice appears. Body temperature rises, intoxication and multiple organ
failure develop.
4) Stage of outcome. The progression of renal and hepatic insufficiency
leads to the death of the patient. If it is possible to restore the function of
the liver and kidneys, then the patient gradually recovers.
Treatmentfor suspected
prolonged tissue compression
syndrome -first aid:
1. Decompression;
2. Anti-shock measures (analgesics);
3. Immobilization of limbs;
4. Treatment of wounds, application of
aseptic dressings;
5. Local tissue cooling (in the area
of compression).
6. With a clearly non-viable limb -the
imposition of a tourniquet to prevent the
restoration of blood flow in the limb.
prolonged tissue compression
syndrome -first aid:
1. Decompression;
2. Anti-shock measures (analgesics);
3. Immobilization of limbs;
4. Treatment of wounds, application of
aseptic dressings;
5. Local tissue cooling (in the area
of compression).
6. With a clearly non-viable limb -the
imposition of a tourniquet to prevent the
restoration of blood flow in the limb.
Treatmentfor suspected prolonged tissue
compression syndrome -treatment in the first
stage:
(it is necessary to reduce the absorption of toxic
substances)
1.limb immobilization,
2.bandaging with elastic bandages,
3.local cooling,
4.vasoconstrictor drugs,
5.Sometimes, novocaineblockades (currently they are rarely
used -only with a sufficient level of blood pressure).
6.narcotic analgesics,
7.Cardiovascular drugs (for low blood pressure),
8.antihistamines,
9.glucocorticoid hormones,
10.antibiotic therapy,
11.Locally -surgical treatment of wounds.
compression syndrome -treatment in the first
stage:
(it is necessary to reduce the absorption of toxic
substances)
1.limb immobilization,
2.bandaging with elastic bandages,
3.local cooling,
4.vasoconstrictor drugs,
5.Sometimes, novocaineblockades (currently they are rarely
used -only with a sufficient level of blood pressure).
6.narcotic analgesics,
7.Cardiovascular drugs (for low blood pressure),
8.antihistamines,
9.glucocorticoid hormones,
10.antibiotic therapy,
11.Locally -surgical treatment of wounds.
Treatmentfor prolonged tissue
compression syndrome -treatment
in the second stage (shock stage):
(fight shock)
1.Antishockdrugs -increase the volume of
infusion therapy with the inclusion of antishock
short circuits (polyglucin, gelatinol);
2.Anti-edematous therapy;
3.Fight against blood acidosis (sodium
bicarbonate)
4.With increasing edema of the limb, stripe
incisions are performed -incisions along the
entire length of the limb with dissection of the
fascia to prevent compression of the muscles by
edematous tissues.
5.Hyperbaric oxygen therapy (HBO).
6.In the presence of dead tissue, a necrectomy
(removal of dead tissue) is performed.
7.In extreme cases, with massive damage to the
soft tissues and the osteoarticularapparatus of
the limb, an early amputation of the limb is
performed.
compression syndrome -treatment
in the second stage (shock stage):
(fight shock)
1.Antishockdrugs -increase the volume of
infusion therapy with the inclusion of antishock
short circuits (polyglucin, gelatinol);
2.Anti-edematous therapy;
3.Fight against blood acidosis (sodium
bicarbonate)
4.With increasing edema of the limb, stripe
incisions are performed -incisions along the
entire length of the limb with dissection of the
fascia to prevent compression of the muscles by
edematous tissues.
5.Hyperbaric oxygen therapy (HBO).
6.In the presence of dead tissue, a necrectomy
(removal of dead tissue) is performed.
7.In extreme cases, with massive damage to the
soft tissues and the osteoarticularapparatus of
the limb, an early amputation of the limb is
performed.
Condition after amputation of the limb
Treatmentof the syndrome of prolonged tissue
compression -treatment in the third stage
(traumatic toxicosis):
(fight against intoxication, anuria)
1.Adequate infusion therapy to stimulate natural detoxification by the
kidneys and liver;
2.Detoxification short circuits (hemodez, polydez);
3.Drugs that improve microcirculation, blood rheology (reopoliglyukin);
4.Fight against blood acidosis (sodium bicarbonate)
5.According to indications transfusion of blood components;
6.Hepatoprotectivedrugs;
7.Forced diuresis -the appointment of diuretics against the background
of the infusion of a large volume of plasma detecting solutions (up to
3-4 liters).
8.Antibiotics to prevent/combat infectious complications.
9.Methods of gravitational surgery: hemosorption, lymphosorption,
plasmapheresis, etc.;
10.In severe cases, with anuria -hemodialysis.
compression -treatment in the third stage
(traumatic toxicosis):
(fight against intoxication, anuria)
1.Adequate infusion therapy to stimulate natural detoxification by the
kidneys and liver;
2.Detoxification short circuits (hemodez, polydez);
3.Drugs that improve microcirculation, blood rheology (reopoliglyukin);
4.Fight against blood acidosis (sodium bicarbonate)
5.According to indications transfusion of blood components;
6.Hepatoprotectivedrugs;
7.Forced diuresis -the appointment of diuretics against the background
of the infusion of a large volume of plasma detecting solutions (up to
3-4 liters).
8.Antibiotics to prevent/combat infectious complications.
9.Methods of gravitational surgery: hemosorption, lymphosorption,
plasmapheresis, etc.;
10.In severe cases, with anuria -hemodialysis.
Нemodialysis
Treatmentfor prolonged tissue compression
syndrome -treatment in the fourth stage
(outcome):
(help with speedy recovery)
1.Adequate infusion therapy to stimulate natural detoxification by the
kidneys and liver;
2.Drugs that improve microcirculation, blood rheology (reopoliglyukin);
3.Antibiotics to prevent/combat infectious complications;
4.Easily digestible, sufficient nutrition in terms of calories, protein and
lipid content;
5.Plastic closure of wounds that have arisen as a result of a primary
injury or in the course of treatment (lamp incisions);
6.Prevention of thromboembolic complications (appointment of
antiplatelet agents, anticoagulants under the control of coagulogram
indicators, activation of the patient).
syndrome -treatment in the fourth stage
(outcome):
(help with speedy recovery)
1.Adequate infusion therapy to stimulate natural detoxification by the
kidneys and liver;
2.Drugs that improve microcirculation, blood rheology (reopoliglyukin);
3.Antibiotics to prevent/combat infectious complications;
4.Easily digestible, sufficient nutrition in terms of calories, protein and
lipid content;
5.Plastic closure of wounds that have arisen as a result of a primary
injury or in the course of treatment (lamp incisions);
6.Prevention of thromboembolic complications (appointment of
antiplatelet agents, anticoagulants under the control of coagulogram
indicators, activation of the patient).
Classification of head injuries
Closed:
• Brain concussion
• brain contusion
• Brain compression
• Fractures of the bones of the
vault and base of the skull
Open:
•Penetrating and non-penetrating
• (in relation to the dura mater).
Closed:
• Brain concussion
• brain contusion
• Brain compression
• Fractures of the bones of the
vault and base of the skull
Open:
•Penetrating and non-penetrating
• (in relation to the dura mater).
Aconcussion-isaninjurytothebrainaccompaniedbya
shortviolationofitsfunction.
Clinicalpicture:Onlycerebralsymptoms.Acharacteristic
symptomisashort-termlossofconsciousness.Inaddition,
dizziness,headache,nausea,sometimes vomiting,and
memorydisordersareobserved.
Mostoften,thevictimdoesnotremember themoment
ofinjuryandashortperiodoftimebeforeinjury-
retrogradeamnesia.
Diagnostics:Examinationbyaneurologistorneurosurgeon,
radiography,CTscanofthebraintoexcludemoresevere
typesofinjuries.
Treatment:bedrestfor2-3weeks,dehydrationtherapy
(40%glucosesolution,hypertonicsolution,40%hexamine
solution,25%magnesiumsolution)aimedatpreventingand
reducingbrainedema.Prescribeanalgesics,sedatives,
sleepingpills.
shortviolationofitsfunction.
Clinicalpicture:Onlycerebralsymptoms.Acharacteristic
symptomisashort-termlossofconsciousness.Inaddition,
dizziness,headache,nausea,sometimes vomiting,and
memorydisordersareobserved.
Mostoften,thevictimdoesnotremember themoment
ofinjuryandashortperiodoftimebeforeinjury-
retrogradeamnesia.
Diagnostics:Examinationbyaneurologistorneurosurgeon,
radiography,CTscanofthebraintoexcludemoresevere
typesofinjuries.
Treatment:bedrestfor2-3weeks,dehydrationtherapy
(40%glucosesolution,hypertonicsolution,40%hexamine
solution,25%magnesiumsolution)aimedatpreventingand
reducingbrainedema.Prescribeanalgesics,sedatives,
sleepingpills.
Abraincontusion-isaninjurytothebrainwithdamageto
themedulla,characterizedbyamoresevereimpairment of
brainfunction.
Clinicalpicture:manifestedbycerebralandfocalsymptoms.
Withabruise,thelossofconsciousnessislongerthanwitha
concussion.Inaddition,nausea,vomiting,bradycardiaareobserved.
Orbital,swallowingreflexes,functionsofthepelvicorgansmaybe
impaired.Focalsymptomsarealsoobserved:paresisandparalysis,
sensitivitydisorders,convulsions,lossofconsciousness,headache
damage(abrasions,wounds,bruises)ofthesofttissuesofthehead
dischargeoffluidfromthenoseorears,bruisingbehindtheearor
aroundtheeyes,anisocoria(pupilsofdifferentsizes).
Dependingontheseverityanddurationofbraindysfunction,3
degreesofseverityofbraincontusionaredistinguished.
Diagnostics:Examinationbyaneurologistorneurosurgeon,
radiography,CT,MRIofthebrainfordifferentialdiagnosisfrombrain
compression,damagetothebonesoftheskull.
Treatment:strictbedrestfor3-4weeks,dehydrationtherapy.
Analgesics,sedatives,hypnotics,prolonged medicalsleep,
symptomatictherapy(preventionofbedsores,enteraltubeand
parenteralnutrition).
themedulla,characterizedbyamoresevereimpairment of
brainfunction.
Clinicalpicture:manifestedbycerebralandfocalsymptoms.
Withabruise,thelossofconsciousnessislongerthanwitha
concussion.Inaddition,nausea,vomiting,bradycardiaareobserved.
Orbital,swallowingreflexes,functionsofthepelvicorgansmaybe
impaired.Focalsymptomsarealsoobserved:paresisandparalysis,
sensitivitydisorders,convulsions,lossofconsciousness,headache
damage(abrasions,wounds,bruises)ofthesofttissuesofthehead
dischargeoffluidfromthenoseorears,bruisingbehindtheearor
aroundtheeyes,anisocoria(pupilsofdifferentsizes).
Dependingontheseverityanddurationofbraindysfunction,3
degreesofseverityofbraincontusionaredistinguished.
Diagnostics:Examinationbyaneurologistorneurosurgeon,
radiography,CT,MRIofthebrainfordifferentialdiagnosisfrombrain
compression,damagetothebonesoftheskull.
Treatment:strictbedrestfor3-4weeks,dehydrationtherapy.
Analgesics,sedatives,hypnotics,prolonged medicalsleep,
symptomatictherapy(preventionofbedsores,enteraltubeand
parenteralnutrition).
Clinical picture-the most common signs found in
patients with traumatic brain injury:
Signs of a fracture of the base of the skull: a) retroauricular
hematoma; b) paraorbital hematomas; c) curvature of the face
(paresis of the right facial nerve), lagophthalmos
patients with traumatic brain injury:
Signs of a fracture of the base of the skull: a) retroauricular
hematoma; b) paraorbital hematomas; c) curvature of the face
(paresis of the right facial nerve), lagophthalmos
An example of CT with a brain contusion with the
formation of a hematoma of the temporal lobe.
formation of a hematoma of the temporal lobe.
Braincompression -causedbyanintracranialhematoma or
bonefragmentsduringaskullfracture.Bloodcanaccumulate
abovetheduramater(epiduralhematoma), underthedura
mater(subduralhematoma), inthethicknessofthebrain
tissue(intracerebralhematoma), intheventriclesofthe
brain.Thecompression ofthebrainismostoftencombined
withacontusionofthebrain.
Clinicalpicture:Acharacteristicsymptomforcompressionofthe
brainisthe"lightgap":thedeteriorationofthepatient'scondition
sometimeaftertheinjury.Common symptoms areincreasing
headaches,bradycardia,lossofconsciousness.Focalsymptoms
dependonthelocationofthehematoma anddysfunctionofthe
compressedpartofthebrain:paralysis,paresis,lossofcertain
reflexes,convulsions.
Diagnostics:Examinationbyaneurologistorneurosurgeon,
radiography,CT,MRIofthebraintodeterminetheareaandnature
ofcompressionofthebrain,damagetothebonesoftheskull.
Accordingtoindications,echography,angiographycanbeperformed.
bonefragmentsduringaskullfracture.Bloodcanaccumulate
abovetheduramater(epiduralhematoma), underthedura
mater(subduralhematoma), inthethicknessofthebrain
tissue(intracerebralhematoma), intheventriclesofthe
brain.Thecompression ofthebrainismostoftencombined
withacontusionofthebrain.
Clinicalpicture:Acharacteristicsymptomforcompressionofthe
brainisthe"lightgap":thedeteriorationofthepatient'scondition
sometimeaftertheinjury.Common symptoms areincreasing
headaches,bradycardia,lossofconsciousness.Focalsymptoms
dependonthelocationofthehematoma anddysfunctionofthe
compressedpartofthebrain:paralysis,paresis,lossofcertain
reflexes,convulsions.
Diagnostics:Examinationbyaneurologistorneurosurgeon,
radiography,CT,MRIofthebraintodeterminetheareaandnature
ofcompressionofthebrain,damagetothebonesoftheskull.
Accordingtoindications,echography,angiographycanbeperformed.
An example of CT with intracerebral hematoma.
An example of CT with an epidural hematoma.
An example of CT (a) and MRI (b) with subdural hematoma.
Treatment: with compression of the brain, an urgent operation
is indicated -craniotomy with elimination of compression
(evacuation of a hematoma or removal of bone fragments);
After the operation, treatment is carried out as with a brain
injury.
is indicated -craniotomy with elimination of compression
(evacuation of a hematoma or removal of bone fragments);
After the operation, treatment is carried out as with a brain
injury.
Classification of chest injuries
Closed:
rib fracture
contusion of soft tissues
of chest
contusion of organs of
chest
Open:
Non-penetrating wounds
Penetrating wounds
Extremely dangerous are not so
much the injuries themselves, but
their complications: hemothorax,
pneumothorax, pleuro-pulmonary
shock, damage to the chest organs.
Closed:
rib fracture
contusion of soft tissues
of chest
contusion of organs of
chest
Open:
Non-penetrating wounds
Penetrating wounds
Extremely dangerous are not so
much the injuries themselves, but
their complications: hemothorax,
pneumothorax, pleuro-pulmonary
shock, damage to the chest organs.
Clinicalpicture:Incaseoffractureoftheribs,localpain,swelling,
hemorrhage.Thepainincreaseswithinhalationandexhalation.On
palpation,crepitusmayoccur-abonecrunch.
Diagnostics:chestx-ray,rarelyCT
Treatment:-withafractureof1-3ribs,mostoftenconservative.With
multiplefracturesoftheribs-sometimesoperational.
Rib fracture
hemorrhage.Thepainincreaseswithinhalationandexhalation.On
palpation,crepitusmayoccur-abonecrunch.
Diagnostics:chestx-ray,rarelyCT
Treatment:-withafractureof1-3ribs,mostoftenconservative.With
multiplefracturesoftheribs-sometimesoperational.
Rib fracture
-accumulationofbloodinthepleuralcavity.
Itcandevelopwithfracturesoftheribs,withrupturesofthelung,with
penetratingwoundsofthechest.
Clinicalpicture:symptomsofinternalbleeding,shortnessofbreath,
withauscultation-weakenedbreathing,withpercussion,dullnessin
thelowersections.
Diagnostics:radiographyofthelungs(horizontalfluidlevel),then(or)
adiagnosticpunctureofthepleuralcavity,inwhichyoureceiveblood
fromthepleuralcavity.Ifnecessary,anadditionalCTscanofthechest
canbeperformed.
Treatment:-withstoppedbleeding-puncturetreatment:puncture
thepleuralcavity(inthe7-8intercostalspacealongtheposterior
axillaryline)andevacuatetheblood.
Withcontinuedbleeding,especiallywithstabwounds,surgical
treatmentisindicated-thoracotomy,bleedingarrest,suturingof
damagedtissues,drainageofthepleuralcavity.
Hemothorax
Itcandevelopwithfracturesoftheribs,withrupturesofthelung,with
penetratingwoundsofthechest.
Clinicalpicture:symptomsofinternalbleeding,shortnessofbreath,
withauscultation-weakenedbreathing,withpercussion,dullnessin
thelowersections.
Diagnostics:radiographyofthelungs(horizontalfluidlevel),then(or)
adiagnosticpunctureofthepleuralcavity,inwhichyoureceiveblood
fromthepleuralcavity.Ifnecessary,anadditionalCTscanofthechest
canbeperformed.
Treatment:-withstoppedbleeding-puncturetreatment:puncture
thepleuralcavity(inthe7-8intercostalspacealongtheposterior
axillaryline)andevacuatetheblood.
Withcontinuedbleeding,especiallywithstabwounds,surgical
treatmentisindicated-thoracotomy,bleedingarrest,suturingof
damagedtissues,drainageofthepleuralcavity.
Hemothorax
An example of a traumatic hemopneumothorax on the
right on the x-ray
right on the x-ray
Shemeof puncture the pleural cavity (in the 7-8
intercostal space along the posterior axillary line) and
evacuate the blood.
intercostal space along the posterior axillary line) and
evacuate the blood.
-accumulationofairinthepleuralcavity.
Itcanbetheresultofeitherapenetratinginjury(airentersthepleural
cavityfromtheexternalenvironment),orafractureoftheribswith
damagetolungtissue(airentersthepleuralcavityfromthelung).The
increasingaccumulationofairinthepleuralcavityleadsto
compressionofthelung.
Distinguish:-open,
-closedand
-valvularpneumothorax.
Clinicalpictureofopenpneumothorax :Withopenpneumothorax,
thepleuralcavitycommunicateswiththeexternalenvironmentthrough
thewoundchannel.Airbubblescomeoutofthewoundduring
breathing,noiseisheard.
Diagnostics:X-rayofthethoraciccavity-youcanseetheairinthe
pleuralcavity
Treatment:evacuationofair,terminationofairaccesstothepleural
cavitybyapplyinganocclusivedressing.
Pneumothorax
Itcanbetheresultofeitherapenetratinginjury(airentersthepleural
cavityfromtheexternalenvironment),orafractureoftheribswith
damagetolungtissue(airentersthepleuralcavityfromthelung).The
increasingaccumulationofairinthepleuralcavityleadsto
compressionofthelung.
Distinguish:-open,
-closedand
-valvularpneumothorax.
Clinicalpictureofopenpneumothorax :Withopenpneumothorax,
thepleuralcavitycommunicateswiththeexternalenvironmentthrough
thewoundchannel.Airbubblescomeoutofthewoundduring
breathing,noiseisheard.
Diagnostics:X-rayofthethoraciccavity-youcanseetheairinthe
pleuralcavity
Treatment:evacuationofair,terminationofairaccesstothepleural
cavitybyapplyinganocclusivedressing.
Pneumothorax
An example of applying a bandage for an open
pneumothorax
pneumothorax
Clinicalpicture:Withaclosedpneumothorax,airentersthepleural
cavityatonceandmostofteninarelativelysmallamount.Thepatient
feelspainintheinjuredpartofthechest,sometimestheremaybe
shortnessofbreath.
Diagnostics:X-rayofthethoraciccavity-youcanseetheairinthe
pleuralcavity
Treatment:puncture(inthesecondintercostalspacealongthe
midclavicularline,thepleuralcavityispunctured,theairisevacuated).
Сlosed pneumothorax
Example:
Spontaneous
pneumothorax on
the right.
cavityatonceandmostofteninarelativelysmallamount.Thepatient
feelspainintheinjuredpartofthechest,sometimestheremaybe
shortnessofbreath.
Diagnostics:X-rayofthethoraciccavity-youcanseetheairinthe
pleuralcavity
Treatment:puncture(inthesecondintercostalspacealongthe
midclavicularline,thepleuralcavityispunctured,theairisevacuated).
Сlosed pneumothorax
Example:
Spontaneous
pneumothorax on
the right.
witheachrespiratorycycle,airentersthepleuralcavity,andwhen
exhaled,theairdoesnotgoout.Atthesametime,airgradually
accumulates,compressesthelung,themediastinalorgansareshifted
tothehealthyside.
Clinicalpicture:thepatienthasprogressiverespiratoryfailure:
shortnessofbreath,cyanosis,increasedheartrate,andadropinblood
pressure.
Diagnostics:radiographyofthelungs(airinthepleuralcavity,
displacementofthemediastinalorgansintheoppositedirection).
Treatment:Withvalvularpneumothorax,emergencycareisneeded.
Attheprehospitalstage,thevalvularpneumothoraxistransferredto
anopenone:thepleuralcavityispuncturedwithathickneedleinthe
secondintercostalspacealongthemidclavicularline,theneedleisnot
removeduntilthevictimisdeliveredtothehospital.Inthehospital,a
catheterisinstalledinthesecondintercostalspace,throughwhichair
isconstantlyevacuated.Ifitisnotpossibletostraightenthelung,then
surgicaltreatmentisnecessary-thoracotomy,suturingofthelung
defect.
Valvular (tense) pneumothorax
exhaled,theairdoesnotgoout.Atthesametime,airgradually
accumulates,compressesthelung,themediastinalorgansareshifted
tothehealthyside.
Clinicalpicture:thepatienthasprogressiverespiratoryfailure:
shortnessofbreath,cyanosis,increasedheartrate,andadropinblood
pressure.
Diagnostics:radiographyofthelungs(airinthepleuralcavity,
displacementofthemediastinalorgansintheoppositedirection).
Treatment:Withvalvularpneumothorax,emergencycareisneeded.
Attheprehospitalstage,thevalvularpneumothoraxistransferredto
anopenone:thepleuralcavityispuncturedwithathickneedleinthe
secondintercostalspacealongthemidclavicularline,theneedleisnot
removeduntilthevictimisdeliveredtothehospital.Inthehospital,a
catheterisinstalledinthesecondintercostalspace,throughwhichair
isconstantlyevacuated.Ifitisnotpossibletostraightenthelung,then
surgicaltreatmentisnecessary-thoracotomy,suturingofthelung
defect.
Valvular (tense) pneumothorax
An example of a valvularpneumothorax on the right.
First aid for valvularpneumothorax
allstabwoundsoftheanterior-lateralsurfaceofthelefthalfofthe
chestaredangerousduetothepossibilityofinjuringtheheart.When
theheartisinjured,itstamponademaydevelop,whentheblood
accumulatedinthepericardialcavitycompressestheheartand
interfereswithitsnormalactivity,whichcanleadtoreflexcardiac
arrest.
Treatment:emergencythoracotomy,pericardiotomy,suturingofthe
woundoftheheart.
Heart wounds
chestaredangerousduetothepossibilityofinjuringtheheart.When
theheartisinjured,itstamponademaydevelop,whentheblood
accumulatedinthepericardialcavitycompressestheheartand
interfereswithitsnormalactivity,whichcanleadtoreflexcardiac
arrest.
Treatment:emergencythoracotomy,pericardiotomy,suturingofthe
woundoftheheart.
Heart wounds
Clinicalcaseofsuccessfultreatmentofstabpenetratingwoundofthe
heart(InoneofthehospitalsoftheRussianFederation)
AtnightonAugust4,2020,a20-year-oldvictimwithastabwoundto
thechestwastakentothehospitalinacriticalcondition.Duringthe
initialexamination,aheartinjurywassuspected.Inthisconnection,
thewoundedmanwasimmediatelytakentotheoperatingroom.
Left-sidedthoracotomywasperformed,about2.5litersofbloodwas
evacuatedfromthepleuralcavity,whichwaspartiallyreinfused.
Revisionofthechestorgansrevealedapenetratingwoundofthe
anteriorwalloftheleftventricleoftheheartwithawoundlengthof3
cmandamarginalwoundtothelung.Thewoundsoftheheartand
lungweresutured.
Heart wounds
heart(InoneofthehospitalsoftheRussianFederation)
AtnightonAugust4,2020,a20-year-oldvictimwithastabwoundto
thechestwastakentothehospitalinacriticalcondition.Duringthe
initialexamination,aheartinjurywassuspected.Inthisconnection,
thewoundedmanwasimmediatelytakentotheoperatingroom.
Left-sidedthoracotomywasperformed,about2.5litersofbloodwas
evacuatedfromthepleuralcavity,whichwaspartiallyreinfused.
Revisionofthechestorgansrevealedapenetratingwoundofthe
anteriorwalloftheleftventricleoftheheartwithawoundlengthof3
cmandamarginalwoundtothelung.Thewoundsoftheheartand
lungweresutured.
Heart wounds
Clinicalcaseofsuccessfultreatmentofstabpenetratingwoundofthe
heart(InoneofthehospitalsoftheRussianFederation)
AtnightonAugust4,2020,a20-year-oldvictimwithastabwoundto
thechestwastakentothehospitalinacriticalcondition.Duringthe
initialexamination,aheartinjurywassuspected.Inthisconnection,
thewoundedmanwasimmediatelytakentotheoperatingroom.
Left-sidedthoracotomywasperformed,about2.5litersofbloodwas
evacuatedfromthepleuralcavity,whichwaspartiallyreinfused.
Revisionofthechestorgansrevealedapenetratingwoundofthe
anteriorwalloftheleftventricleoftheheartwithawoundlengthof3
cmandamarginalwoundtothelung.Thewoundsoftheheartand
lungweresutured.
Heart wounds
heart(InoneofthehospitalsoftheRussianFederation)
AtnightonAugust4,2020,a20-year-oldvictimwithastabwoundto
thechestwastakentothehospitalinacriticalcondition.Duringthe
initialexamination,aheartinjurywassuspected.Inthisconnection,
thewoundedmanwasimmediatelytakentotheoperatingroom.
Left-sidedthoracotomywasperformed,about2.5litersofbloodwas
evacuatedfromthepleuralcavity,whichwaspartiallyreinfused.
Revisionofthechestorgansrevealedapenetratingwoundofthe
anteriorwalloftheleftventricleoftheheartwithawoundlengthof3
cmandamarginalwoundtothelung.Thewoundsoftheheartand
lungweresutured.
Heart wounds
Heart wounds
Clinical case
Clinical case
Clinicalcase:Thepostoperativeperiodproceeded without
complications.Dischargedfromthehospitalinasatisfactorycondition
onthe17thdayaftersurgery.
Heart wounds
complications.Dischargedfromthehospitalinasatisfactorycondition
onthe17thdayaftersurgery.
Heart wounds
Classification of closed abdominal
injuries
Closed:
-Closed injuries of the abdominal organs
-Damage to the retroperitoneal organs
-Abdominal wall injury
Open (wounds):
-Non-penetrating wounds (peritoneum
intact)
-Penetrating wounds (damaged
peritoneum):
-with damage to internal organs
-no damage to internal organs (rare)
injuries
Closed:
-Closed injuries of the abdominal organs
-Damage to the retroperitoneal organs
-Abdominal wall injury
Open (wounds):
-Non-penetrating wounds (peritoneum
intact)
-Penetrating wounds (damaged
peritoneum):
-with damage to internal organs
-no damage to internal organs (rare)
Classification of closed abdominal
injuries
Clinicalpicture:maybeaccompaniedbybruisingofthe
anteriorabdominalwall,aswellasdamagetointernalorgans.
If there is damage to the parenchymal organs (ruptures of
the liver, spleen), then there is a clinic of internal bleeding:
anemia, abdominal pain, a drop in red blood counts,
tachycardia, a drop in blood pressure, pallor of the skin,
dizziness, weakness.
If hollow organs are damaged (ruptures of the small and
large intestines, rupture of the stomach, bladder), a clinical
picture of peritonitisdevelops: muscle tension of the anterior
abdominal wall, abdominal pain, symptoms of peritoneal
irritation, tachycardia, leukocytosis, intestinal paresis.
injuries
Clinicalpicture:maybeaccompaniedbybruisingofthe
anteriorabdominalwall,aswellasdamagetointernalorgans.
If there is damage to the parenchymal organs (ruptures of
the liver, spleen), then there is a clinic of internal bleeding:
anemia, abdominal pain, a drop in red blood counts,
tachycardia, a drop in blood pressure, pallor of the skin,
dizziness, weakness.
If hollow organs are damaged (ruptures of the small and
large intestines, rupture of the stomach, bladder), a clinical
picture of peritonitisdevelops: muscle tension of the anterior
abdominal wall, abdominal pain, symptoms of peritoneal
irritation, tachycardia, leukocytosis, intestinal paresis.
Classification of closed abdominal
injuries
All victims with a closed abdominal injury are subject to
mandatory hospitalization.
Diagnostics:
Diagnosis of injuries of the abdominal organs is often
difficult, a surgeon's examination and additional examination
methods are necessary: a survey radiography of the
abdominal organs -when hollow organs rupture under the
dome of the diaphragm, free gas is determined, the so-called
"sickle" symptom.
If intra-abdominal bleeding is suspected, puncture,
laparocentesis, ultrasound, CT of the OBP, laparoscopy are
possible. If, with these methods of examination, blood,
intestinal contents, exudate are found in the abdominal
cavity, then a laparotomy is performed with a complete
revision of all abdominal organs.
injuries
All victims with a closed abdominal injury are subject to
mandatory hospitalization.
Diagnostics:
Diagnosis of injuries of the abdominal organs is often
difficult, a surgeon's examination and additional examination
methods are necessary: a survey radiography of the
abdominal organs -when hollow organs rupture under the
dome of the diaphragm, free gas is determined, the so-called
"sickle" symptom.
If intra-abdominal bleeding is suspected, puncture,
laparocentesis, ultrasound, CT of the OBP, laparoscopy are
possible. If, with these methods of examination, blood,
intestinal contents, exudate are found in the abdominal
cavity, then a laparotomy is performed with a complete
revision of all abdominal organs.
An example of a picture on the chest x -ray in the
presence of gas in the abdominal cavity
(the presence of crescent-shaped enlightenment under
the right dome of the diaphragm).
presence of gas in the abdominal cavity
(the presence of crescent-shaped enlightenment under
the right dome of the diaphragm).
An example of a picture on the radiograph of the organs
of the abdominal cavity in the presence of a foreign body
in the abdominal cavity
of the abdominal cavity in the presence of a foreign body
in the abdominal cavity
An example of a picture on the radiograph of the organs
of the abdominal cavity with intestinal paresis (the
formation of liquid levels with the accumulation of gas
above it -Kloiber'scups)
of the abdominal cavity with intestinal paresis (the
formation of liquid levels with the accumulation of gas
above it -Kloiber'scups)
An example of a picture on ultrasound in the presence of
free fluid in the abdominal cavity.
free fluid in the abdominal cavity.
Wounds ofabdomenal wallcanbenon-penetratingand
penetratingintotheabdominalcavity.
Toclarifythediagnosisinallcases,surgicaltreatmentofthewound
isperformed:theedgesofthewoundareexcised,thewoundis
expanded(translatedintoacutform),andtheentirewoundchannel
isrevised.
Ifduringtherevisionitisfoundthatthewoundchannelpenetrates
intotheabdominalcavity,thenamandatoryoperationisnecessary-
laparotomy,revisionofallabdominalorgans.Thefinalvolumeofthe
operationdependsonthetypeofdamagedorgans.
penetratingintotheabdominalcavity.
Toclarifythediagnosisinallcases,surgicaltreatmentofthewound
isperformed:theedgesofthewoundareexcised,thewoundis
expanded(translatedintoacutform),andtheentirewoundchannel
isrevised.
Ifduringtherevisionitisfoundthatthewoundchannelpenetrates
intotheabdominalcavity,thenamandatoryoperationisnecessary-
laparotomy,revisionofallabdominalorgans.Thefinalvolumeofthe
operationdependsonthetypeofdamagedorgans.
Thank you for your attention!
Ready to answer your questions.
Ready to answer your questions.
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