Of thoraco-abdominal injury

Of thoraco-abdominal injury - simultaneous injuries of the chest, the diaphragm and the abdomen. Can be capped and may be accompanied by a rupture of the diaphragm (with compression of the thorax and abdomen during avalanches on mines, railway accidents, and open, when the same painful subject (bullet, bayonet, a knife), damaging the chest and diaphragm, penetrates into the abdominal cavity. The wound aperture entails two cavities (thoracic and abdominal) with different internal pressure. In connection with the suction action of the chest into the chest cavity can move abdomen organs - gland, stomach, intestinal loop - through the wound breast fall out. For the thoraco-abdominal injury characterized by the simultaneous presence of the patient as symptoms injuries of the thoracic cavity - pneumothorax (see) or hemothorax (see)and the abdominal cavity, intra - abdominal bleeding or peritonitis (see). The penetration of the intestinal loops in the chest cavity can lead to infringement of their small wound diaphragm and intestinal obstruction, and further to the mortification. Of thoraco-abdominal injuries are often accompanied by shock (see).
The General condition of victims of severe: dyspnea, cyanosis, cough, sudden pain in the chest and abdomen. The pulse is small, frequent, blood pressure is lowered. Auscultation of the chest-side damage is sometimes possible to hear noise of intestinal peristalsis; x-ray examination of the thorax is possible to identify the offset of the bodies of the mediastinum in the opposite direction, the presence of a hollow organ abdominal cavity above the level of the diaphragm. Reliable sign of thoraco-abdominal injuries - after gastric or intestinal contents from the wounds of the chest, loss of it section of the gland or intestinal loops.
First aid for thoracoabdominal injuries is reduced to the imposition of sterile bandages (in case of open pneumothorax - hermetic) on the wound, the introduction of heart drugs, mandatory inhalation humidified oxygen and fastest transportation (only on a stretcher!) the victim in the nearest surgical hospital. In cases falling through the wound of the chest viscera the reset not to produce, limited to wrap them with a sterile bandage. Pain relievers (promedol) is entered only in case of availability of reliable signs of thoraco-abdominal injury. Morphine should not be entered, as it oppressing breathing center. Most shows at transportation of the victim with the thoraco-abdominal injuries mask anesthesia, nitrous oxide, which stops directly after removal of the mask.
Treatment of thoraco-abdominal injuries operational preliminary protivosokovh activities, starting with vagosimpatical cervical procaine blockade on the side of damages (see Blockade procaine), blood transfusion or its substitutes. The objectives of the operation are: stop the bleeding, eliminate the source of peritonitis, suturing wounds aperture, internal organs and the chest wall. The operation will end the mandatory separation of drainage of the pleural cavity removal of the exudate and often in the abdomen for the introduction of antibiotics. Patients with thoracoabdominal injuries to the introduction of prophylactic doses of tetanus serum in the amount of 3000 AE.
After surgery, the patient must be in a semi-sitting position. Appointed oxygen, pain, heart, antibiotics. Through drainage, located in the pleural cavity, is continuous or periodic aspiration by connecting with vacuum system, valve submarine drainage or syringe Jean. The drain is removed in 3-4 days.
Forecast when the thoraco-abdominal injuries depends on the nature of damage to internal organs and timing of surgical services.