01:12,28,Jan,2007 | (1088/0/0) | Original
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Blood in the pleural cavity from:
(1) lung tissue laceration bleeding. As low pressure pulmonary circulation, generally less bleeding and slow, and more are free to stop;
(2) thoracic intercostal blood vessels or blood vessels broken blood loss. If the high pressure arteries involved, the amount of bleeding, not easy to automatically stop, and often require surgery to stop bleeding;
(3) damage to the heart and great vessels rupture. The amount of bleeding and rapid, if not early treatment. Often in the short term lead to hemorrhagic shock and death.
Hemothorax occurred, not only because of loss of blood volume and internal bleeding signs, and with the accumulation of the pleural cavity and the blood pressure increased, forcing the lungs collapse, and into the contralateral mediastinal, and thus seriously affect the respiratory and circulatory function , blood in the pleural cavity, the lungs, heart and diaphragm to fibrin plays a role, many are not solidified. If a lot of blood in the short term, to the role of fibrin imperfect, can be solidified into a blood clot. Unit of blood clots, the formation of fibrous tissue binding the lung and thorax, restrict breathing exercises, respiratory damage. Blood is a good medium for bacteria. From the wound or lung rupture into the bacteria breed quickly in the blood in the breed. Therefore, blood in the pleural cavity if not discharged, easy to concurrent infections, the formation of empyema.
Injury in the pathophysiology of hemothorax 2009-10-30 19:14
Injury hemothorax hemothorax occurred when blood volume is lost not only because of the circulatory function, blood loss signs appear; also because of increased blood volume, pressure to collapse the lung ipsilateral and contralateral mediastinal push that also affected the contralateral lung pressure, respiratory area reduction and return of vena cava, seriously affecting the respiratory and circulatory functions.
When the rapid accumulation of pleural lot of blood in a short time, more than lung, pericardium and diaphragm movement to go from the role of fibrin, blood in the chest cavity solidification occurs, the formation of coagulated hemothorax. Unit of blood clot formation after the fiber, limiting activities of lung and thorax, damage respiratory function.
Blood is a good culture medium, the mouth of the wound or lung rupture of `invasive medical education network collected more bacteria in the blood in the rapidly growing breed. Hemothorax caused by infection, leading to empyema.
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The content (points) and time allocation:
First, review the anatomical and physiological characteristics of the chest, the classification of chest injury 20
1: blunt trauma
2: open injury
3: thoraco-abdominal injuries
Second, first-aid principles and the indications for exploratory thoracotomy; 8
(1) pleural cavity bleeding.
(2) extensive pulmonary laceration, bronchial rupture (after continuous thoracic drainage is still a lot of leakage, difficulty breathing no improvement).
(3) The heart and great vessel injury.
(4) thoraco-abdominal injuries.
(5) intrathoracic foreign bodies.
Third, the cause of rib fracture, classification, clinical manifestations, diagnosis and treatment principles; 12
1. Cause: most likely to occur in 4-7 rib (long and fixed).
Direct violence - inward bending fracture stress points
Indirect violence - bending fracture stress points out
2. Category: single single single office or multiple
Multiple or single at the root of many
3. Pathophysiology and clinical manifestations:
(1) â†’ fracture site pain, chest wall contusion (a wound or ecchymosis), thoracic deformity, local tenderness, a sense of bone rubbing.
(2) fracture punctured lung and vascular â†’ (1) pneumothorax, hemothorax â†’ subcutaneous emphysema, atelectasis, mediastinal shift â†’ breathing difficulties
(2), bloody sputum, hemoptysis.
(3) abnormal chest wall retraction or softening â†’ breathing, hypoxia and CO2 â†’ mediastinal swing retention, venous reflux disorder
â†’ respiratory and circulatory failure
(1) medical history, symptoms and signs.
(2) X line: rib fractures, blood pneumothorax, atelectasis, mediastinal shift, etc.
â‘ Single Office Closed treatment of rib fracture:
Focus on pain (intercostal nerve block economic), fixed (tape) and to prevent complications.
â‘¡ multiple rib fractures with closed treatment of multiple:
Focus is fixed and the control of abnormal breathing, keep the airway open.
Fixation methods: (1) bandage.
(4) tracheostomy breathing aid.
â‘¢ open rib fracture treatment:
Debridement, fixed, anti-infection.
Thoracic drainage, anti-shock .
Fourth, the classification of pneumothorax, all types of pneumothorax, clinical manifestations, diagnosis and treatment principles. 15
First, the definition of 8
1, Definition: pleural cavity product gas.
2, cause: lung tissue, bronchial rupture, chest wounds, puncture the pleura.
Second, the classification of 8
Closed pneumothorax, open pneumothorax, tension pneumothorax.
Third, closed pneumothorax 9
1, a small amount of pneumothorax (lung collapse "30%): No obvious symptoms, no special treatment, 1-2 weeks, self-absorbed.
2, a large pneumothorax (lung collapse> 30%): chest tightness, chest pain, shortness of breath, to the contralateral tracheal shift, buckle diagnosis drum sounds, breath sounds decreased or disappeared. X-ray showed atelectasis and pleural pneumoperitoneum. In need of pumping or drainage of pleural cavity puncture to prevent infection.
Fourth, open pneumothorax
1, pathophysiology and clinical manifestations
(1) pleural atelectasis product gas â†’ â†’ shortness of breath, drum sounds, breath sounds decreased or disappeared, and mediastinal shift.
(2) bilateral pleural pressure changes â†’ â†’ flutter mediastinal venous disorders, circulatory disorders â†’ shock.
(3) of the repeated exchange of air in the lungs on both sides of severe hypoxia â†’ â†’ breathing difficulties and cyanosis.
(4) â†’ open wound chest hair hear the sound (due to air out of the pleural cavity).
(1) medical history, symptoms and signs.
(2) chest X-ray: pleural pneumoperitoneum, lung collapse.
(3) pleural biopsy: diagnosis
Focus: the open pneumothorax into a closed pneumothorax, further processing (dressing or debridement the wound sealed.) Anti-shock, anti-infection, if necessary, exploratory thoracotomy lung or bronchial cleft repair.
Second, tension pneumothorax
Large and deep lung or bronchial valve caused cracks to form.
1, pathophysiology and clinical manifestations:
Pleural pressure increases â†’ the injured side completely collapse the lung, mediastinal shift â†’ extreme difficulty breathing, orthopnea, cyanosis, irritability, coma, asphyxia; bilateral chest overeating, emphysema, high degree of drum sounds, breath sounds disappeared .
X-ray examination: a large number of product gas pleural cavity, lung completely collapsed.
Pleural pressure gas out of the puncture can be confirmed.
Focus: the tension pneumothorax into an open pneumothorax, and then open pneumothorax treatment.
(1) First aid treatment: an immediate discharge, reducing the pleural cavity pressure (needle thoracentesis exhaust).
(2) Formal processing: the second intercostal space mid clavicular line connection seal placed chest tube bottles, if necessary, add
(3) a serious leak, no improvement in dyspnea or prolonged air leakage should be carried out exploratory thoracotomy.
First, the concept of hemothorax, pathophysiological changes, clinical manifestations and diagnosis of pleural hemorrhage the source of the hemothorax diagnostic criteria, principles of hemothorax;
First, the definition of
Chest injuries caused by blood in the pleural cavity.
1, a small amount of hemothorax: Adult less than 500 ml
2, in the amount of hemothorax :500-1000 ml
3, massive hemothorax: 1000 ml or more
Third, the source of blood in the pleural cavity
1, lung laceration bleeding.
2, vascular or thoracic intercostal broken blood vessel damage
3, damage to the heart and large blood vessels rupture.
Fourth, pathophysiology and clinical manifestations
1, a small amount of blood, chest: no obvious symptoms, only the X-ray examination showed costophrenic sinus disappear.
2, the massive hemothorax: cause respiratory and circulatory dysfunction
(1) â†’ pleural effusion, atelectasis, mediastinal shift â†’ shortness of breath, difficulty breathing; intercostal full, tracheal shift, dullness, breath sounds decreased or disappeared.
(2) hemorrhagic hypovolemic shock â†’ â†’ weak rapid pulse, blood pressure, shortness of breath.
(3) heavy bleeding â†’ freezing â†’ BOOP hemothorax hemothorax.
(4) â†’ concurrent blood in the pleural cavity infection, the formation of empyema.
1, X-ray examination: the injured side of a large pleural effusion shadow (liquid surface), mediastinal shift.
2, chest to wear: out of the blood can be confirmed.
3, suggesting that the signs of bleeding
(1) gradually faster pulse, blood pressure continued to decline;
(2) through blood transfusion or infusion increased blood pressure does not rise and then drop rapidly;
(3) hemoglobin, red blood cell count and hematocrit continued to decrease;
(4) chest X ray examination revealed a continuous increase of the shadow of the pleural cavity;
(5) chest drain blood 3 consecutive hours per hour over 200 ml.
1, non-progressive hemothorax:
(1) a small hemothorax: can naturally absorb, without aspiration.
(2), massive hemothorax: Closed chest drainage.
2, the hemothorax: timely exploratory thoracotomy.
(1) intercostal or thoracic vascular bleeding, bleeding to ligation.
(2) suture bleeding lung gap, if necessary, must be part of the lung resection or lobectomy.
(3) major vascular rupture: repair or artificial vascular graft.
3, coagulated hemothorax: bleeding stopped within a few days after the thoracotomy clear blood clots.
Second, the indications for closed thoracic drainage, drainage tube placement and drainage tubes were removed the location indication;
1, the indications:
(1), pneumothorax, hemothorax or empyema requires continuous discharge, blood or pus discharge were.
(2) pleural cavity by incision.
2, the drainage pipe parts:
(1) the second intercostal space mid clavicular line - the exhaust.
(2) axillary line and posterior axillary line between intercostal 6-8 - drain.
(1) drainage tube no longer has gas emissions.
(2) 24-hour drainage of fluid less than 50 ml.
(3), lung auscultation, breath sounds clear.
(4) X-ray examination showed good lung expansion.
Third, changes in the pathophysiology of pericardial blood, clinical manifestations, Beck triad significance, diagnosis and emergency treatment;
Fourth, understand the heart and great vessel injury, traumatic asphyxia, pulmonary blast injury, the concept of thoraco-abdominal injuries and treatment methods.
Chest, directly or indirectly due to the impact of violence, falls, violent shocks or sudden acceleration and deceleration - hanging in the heart of the collision sternum or spine. Because the right ventricle close to the sternum, the most easy to bruise.
First, cardiac contusion
1, the clinical manifestations
Light may asymptomatic. Severe chest pain occurred, palpitation, dyspnea, pericardial friction rub; ECG ST â†‘, T wave low-lying inversion, arrhythmia. Creatine kinase - isoenzymes (CPK-MB) and lactate dehydrogenase (LDH) â†‘. Echocardiography can help diagnose.
Bed rest, oxygen, make up the volume, anti-arrhythmia, heart failure, digitalis application.
Second, cardiac rupture
Common fracture sites were right ventricle, left ventricle, right atrium, sitting room, large blood vessels.
1, the clinical manifestations
Signs of cardiac tamponade (Beck triad):
(1) venous hyp
(2) weak heartbeat, heart sounds distant.
(3) arterial blood pressure.
Symptoms of hypovolemic shock occurs, death may be due to bleeding. Pericardiocentesis out of the blood can be confirmed.
Emergency surgical treatment. Into the left chest through the fourth intercostal chest, cut the pericardium, probe heart wall cracks, interrupted suture.
Third, ventricular septal perforation
Often occurs near the apex of septum, left to right shunt occurs, heard in the systolic murmur left sternal border with tremor. UCG or cardiac catheterization can be used for diagnosis. Stable disease for 2-3 months after the line defect repair.
Fourth, valve, chordae, papillary muscle injury
Rupture of the aortic valve, mitral valve chordae tendineae and papillary muscle rupture more common, resulting in valve regurgitation caused by acute heart failure, heart murmur occurs. UCG can help diagnosis. Be implemented more valvuloplasty or valve replacement.