Chest Trauma: Diagnosis and Management by Priv.-Doz. Dr. Werner Glinz (auth.)

By Priv.-Doz. Dr. Werner Glinz (auth.)

Expanded wisdom concerning the pathophysiologic results of serious in­ juries, developments within the in depth care of sufferers of a number of accidents, and the therapy made attainable by means of modem cardiovascular surgical procedure make it seem brilliant to mix the review and treatment of thoracic accidents right into a synthesis of assorted branches of drugs. This monograph, for that reason, is meant not just for the expert in thoracic or cardiac surgical procedure but additionally basically for the person that is the 1st to be faced through thoracic accidents, specifically, the overall health care provider or the traumatologist. It displays my very own own adventure as leader doctor of an emer­ gency surgical procedure ward of a college health center and as head of an inten­ sive care unit for the significantly wounded, which treats good over a hundred sufferers with critical thoracic accidents each year, and relies on an research of those circumstances. My event as an army doctor in Vietnam was once additionally considered. Many wounds within the quarter of the thorax will be effectively taken care of with uncomplicated, conservative methods, although through "conservative" i don't suggest to indicate "inactive." An competitive conservatism is desire­ ed, which needs to concentrate on small information. In given instances, how­ ever, it calls for the short decision-making potential of the com­ petent doctor. consequently, huge area is dedicated to questions of overview and useful procedures.

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Diaphragmatic Rupture Opacities in the thoracic area that are sharply defined, as well as opacities with areas of increased translucence corresponding to air in the displaced magenblase or intestinal loops, suggest a rupture of the diaphragm (Fig. 4). The displacement of the mediastinum to the opposite side is often more pronounced in these cases than in corresponding opacification caused by hemothorax. It happens again and again that the stomach or the intestinal loops are injured in the attempt to drain what is thought to be a hemothorax.

The accumulation of secretions can lead to formation of atelectasis or infection. These deleterious consequences, which often cause a secondary respiratory insufficiency, can be prevented by adequate analgesia and above all by intensive breathing exercises, which are begun on the day of the accident. By itself, paradoxical respiration involving a free fragment of chest wall resulting from multiple double rib fractures is not an indication for ventilatory assistance. Only with evidence of respiratory failure is long-term mechanical ventilation unavoidable, unless it is one of the rare cases where surgical stabilization of the thoracic wall promises to be successful.

V. Adult Respiratory Distress Syndrome (ARDS) The term "adult respiratory distress syndrome" (ARDS) should be used in a restrictive sense for a well-defined posttraumatic pathologic condition. It is characterized by a substantial intrapulmonary right-to-Ieft shunt, a decreased functional residual capacity, and an interstitial lung edema (Fig. 17). Characteristic findings in early stages are listed in Table 7. Table 7. Characteristic findings in the early stages of ARDS Arterial P0 2 t Arterial PC0 2 normal (in rare cases t: hyperventilation) Cardiac output t Right-to-left shunt t Functional residual capacity t Interstitial lung edema The pathologic condition is defined by its functional consequences, not by its etiology.

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