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Thoraco-abdominal damage

Thoraco-abdominal injuries are simultaneous injuries of the chest, diaphragm and abdomen. They can be closed and accompanied by a rupture of the diaphragm (when the chest and abdomen are squeezed during mine collapses, railway accidents), and also open when the same injuring object (bullet, bayonet, knife), damaging the chest and diaphragm, penetrates abdominal cavity. The wound of the diaphragm entails the communication of two cavities (chest and abdominal) with different internal pressure. Due to the suction effect of the chest, the organs of the abdomen — the omentum , stomach, intestinal loops — can move into the pleural cavity and fall out through the wound of the chest. For thoraco-abdominal damage is characterized by the simultaneous presence of the patient as symptoms of damage to the organs of the chest cavity - pneumothorax (see) or hemothorax (see), and the abdominal cavity - intraperitoneal bleeding or peritonitis (see). Penetration of intestinal loops in the chest cavity can lead to their infringement in a small wound of the diaphragm and intestinal obstruction, and subsequently to death. Thoraco-abdominal injuries are often accompanied by shock (cm).

The general condition of the victims is severe: shortness of breath, cyanosis , cough, sharp pains in the chest and abdomen. Pulse small, frequent, blood pressure is reduced. When auscultation of the breast on the side of the damage, you can sometimes hear the noise of intestinal motility; X-ray examination of the chest can reveal the displacement of the mediastinal organs in the opposite direction, the presence of a hollow organ of the abdominal cavity above the level of the diaphragm. A reliable sign of thoraco-abdominal damage is the outflow of gastric or intestinal contents from the chest wound , the loss of an omentum or intestinal loop from it.

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First aid for thoracoabdominal injuries is reduced to the imposition of a sterile dressing (with open pneumothorax - hermetic) on the wound, the introduction of cardiac means, obligatory inhalation of moistened oxygen and the fastest transportation (only on stretchers!) Of the injured to the nearest surgical hospital. In cases of loss through the wound of the chest, the viscera do not reduce the viscera, limiting themselves to wrapping them with a sterile dressing. Painkillers ( promedol ) are administered only if there are reliable signs of thoraco-abdominal damage. Morphine should not be administered, as it depresses the respiratory center. The most indicated during transportation of the victim with thoraco-abdominal injuries is mask anesthesia with nitrous oxide, which is terminated immediately after removal of the mask.

Treatment of thoraco-abdominal injuries is operative, with preliminary anti-shock measures, starting with a vagosympathetic cervical novocaine blockade on the side of damage (see Novocain blockade), blood transfusion or its substitutes. The objectives of the operation are: to stop bleeding, eliminate the source of peritonitis, suturing the wounds of the diaphragm, internal organs and chest wall. The operation ends with the obligatory leaving of drainage in the pleural cavity to remove exudate and often in the abdominal cavity for the administration of antibiotics. Patients with thoracoabdominal lesions require administration of a prophylactic dose of tetanus toxoid in the amount of 3000 AU.

After surgery, the patient should be in a semi-sitting position. Appointed oxygen, painkillers, heart, antibiotics. Through the drainage, which is in the pleural cavity, constant or periodic aspiration is carried out by connecting with a vacuum system, valve subsea drainage or a Jean syringe . Drainage is removed in 3-4 days.

The prognosis for thoraco-abdominal injuries depends on the nature of the damage to the internal organs and the timing of surgical care.