With various impacts, these can be blows, compression, body concussion, gunshot and puncture wounds. To injuries internal organs include injuries to the heart, lungs, stomach, intestines, liver, spleen, pelvic organs, traumatic brain and spinal cord injuries. These injuries are accompanied by blood loss, the development of shock, purulent complications, can be life-threatening. Errors in first aid can also have serious consequences.

Damage to internal organs.

Types of damage:

Bruises (or contusions) are manifested by areas of hemorrhage in the organ.
Cracks - most often occur in the capsule covering the organ, less often, under it.
Tears are damage that does not reach the middle of the organ.
Ruptures are deeper injuries and can be complete or incomplete.
Avulsions are the separation of an organ from the ligaments that support it.
Crush injuries are the destruction of organ tissue.

Injuries to internal organs are classified into open and closed. In open injuries, there is a wound opening that connects the body cavity with the external environment.

Organ damage chest cavity.

The chest cavity contains the heart and lungs - vital organs. Their injuries are life-threatening.

Lung damage.

The most common injury to the lung is a bruise. Foci of hemorrhage appear in the lung tissue. The sign is difficulty breathing, but there may be no symptoms.
Rupture of the trachea, bronchus. It happens when there is compression of the chest. Manifested by cyanosis of the skin, cough, discharge of blood from the respiratory tract. The victim develops shock and death is possible.
Lung rupture is a serious injury that leads to the entry of air into the pleural cavity. Hemoptysis appears. Blood pressure will drop, the pulse becomes rapid, severe shortness of breath and chest pain occur. Usually hemothorax (accumulation of blood in the pleural cavity) or pneumothorax (accumulation of air in it) develops. In this condition, difficulty breathing increases. Air enters the subcutaneous fatty tissue, so when you feel the skin you can feel a crunch (subcutaneous emphysema). If a lung rupture occurs as a result of a chest injury, an open pneumothorax develops, which leads to the entry of atmospheric air into the pleural cavity. As a result, the lung collapses and the heart becomes displaced.

Heart damage.

Closed cardiac injuries include concussion, contusion, and cardiac rupture. Open injuries include wounds to the heart.

Concussion of the heart. The victim's condition is not serious. Signs: aching pain in the heart area, irregular tones, dizziness, fainting.
Heart bruise. Heart pain is constant or intermittent. The tones are irregular, shortness of breath is characteristic.
Heartbreak. A very serious injury. Signs are pale skin, heart sounds are practically not heard, the pulse is weak, frequent, irregular, breathing is rapid.
Heart injury. This is a life-threatening injury. The signs are the same as for a closed heart rupture.

First aid for chest injuries.

If there is a wound on the chest wall with foam oozing, it is necessary to urgently apply a sealed bandage until the doctors arrive. You can use oilcloth or film as a material for the bandage. The victim should be in a sitting position, not talk and breathe shallowly.

Organ damage abdominal cavity.

Closed injuries occur when a blow to the stomach or a fall on a hard object occurs. Open injuries occur when injured by sharp objects or weapons. The abdominal cavity contains parenchymal and hollow organs.

Damage to parenchymal organs (liver, spleen). Bleeding develops into the abdominal cavity. There are all the signs of blood loss - pale skin, sticky cold sweat, dizziness, drop in blood pressure, rapid weak pulse, tension in the abdominal muscles. The victim feels severe pain and is in a state of shock.
Damage to hollow organs (stomach, intestines). The contents of the organ penetrate into the abdominal cavity. As a result, in addition to blood loss, a picture of peritonitis (purulent or fecal) is observed. Peritonitis is an inflammatory process in the peritoneum covering the internal organs. It is characterized by a position on the side with tucked knees, severe increasing pain in the abdomen, a hard “board-shaped” abdomen, and shock.
For small ruptures of hollow organs located behind the peritoneum (pancreas, duodenum), or with ruptures in two stages (damage to the tissue of the liver, spleen, and then the capsule), the signs may not be expressed.

Damage to retroperitoneal organs.

The kidneys are often damaged during closed abdominal trauma.

Kidney bruise. Characterized by lower back pain and small amounts of blood in the urine.
Kidney rupture. The pain in the lower back is more pronounced, the lumbar region is swollen, and there is a lot of blood in the urine. Peritonitis may develop.
Gap Bladder. Usually occurs with fractures of the pelvic bones. The victim feels severe pain above the womb, this area is swollen. Peritonitis is characteristic of ruptures of the intraperitoneal part. There is a lot of blood in the urine.

First aid for injuries to the abdominal organs and retroperitoneal space.

In case of an open abdominal injury, a sterile bandage should be applied to the wound, and a sealed material (film, bag) on top, secured with a bandage, and cold applied. If internal organs have fallen out, they should not be inserted into the wound. Taking water, food, and medicines is prohibited. The victim should be taken to the doctor in a position comfortable for him.

Brain damage.

Closed head injuries are more common. This is a concussion, bruise and compression of the brain.

Brain concussion. Loss of consciousness is short-term. Characterized by headache, nausea, and possible vomiting. The pulse is increased.
Brain contusion. A person loses consciousness for more than long term, and then does not remember the event that happened before the injury. With severe bruises, there may be paresis, paralysis of the limbs, and speech impairment. The victim is often in an excited state. Characterized by vomiting and different diameters of the pupils of the eyes.
Compression of the brain. The brain can be compressed by blood pouring out of the vessels and bone fragments. The symptoms are the same as for a bruise, but they increase quickly.

First aid for traumatic brain injury.

Before the medical team arrives, it is necessary for the victim to be at rest, in a supine position. The head should be turned to the side so that in case of vomiting the person does not choke. If there is no breathing or heartbeat, resuscitation measures must be started immediately.

Spinal cord injuries.

Spinal cord injuries occur when the spine is fractured. There is a concussion, bruise, compression and hemorrhage in the spinal cord.

Spinal cord concussion. More minor injury. Characterized by decreased tendon reflexes, muscle weakness, and sensory disturbances in the arms or legs. These symptoms usually last no more than a week.
Spinal cord contusion. Signs: persistent paralysis or paresis of the legs or arms, absence of tendon reflexes, impaired sensitivity. The location of these symptoms depends on the level of damage.
Spinal cord compression. The brain may be compressed by vertebral fragments or a hematoma. The symptoms are approximately the same as with a bruise. They may appear immediately after injury or develop gradually.
Hemorrhage in the spinal cord. Depending on which membrane of the brain the blood spilled into, signs appear at different speeds - pain in the limbs, back, then paresis or paralysis, disorders of the pelvic organs.

First aid for spinal cord injury.

If cardiac activity and breathing stop, resuscitation measures should be started. If possible, there is no need to turn or transport the victim until medical examination is performed. In cases where it is impossible to leave a person at the scene of the incident and there are several assistants, it is necessary to carefully place the victim on a shield or rigid stretcher, while fixing his head. You should transport it very carefully and constantly monitor its condition.

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Signs of hemothorax: severe general condition, low blood pressure, rapid thready pulse, shortness of breath, shortening of percussion sound, mediastinal displacement, absence of breath sounds over the damaged half of the chest. The skin is pale bluish as a result of the adjoining ARF, which masks the developing anemia. The x-ray shows a dense shadow covering the lower part or the entire lung.

Treatment. Pleural puncture and installation of drainage (Fig. 1) in the seventh-eighth intercostal space between the middle axillary and scapular lines. Replenishment of blood volume.

Rice. 1. Stages (a, b) of drainage of the pleural cavity according to Bulau

Indications for thoracotomy: rapid blood loss (more than 100-200 ml/h), ongoing bleeding (more than 1 liter in total), as evidenced by the coagulation of evacuated blood (Rouvilois-Gregoire test).

When the lungs are injured by sharp fragments of the ribs, the bleeding is usually not profuse and tends to stop on its own. There is no doubt that hemothorax complicates chest injuries more often, but the accumulation of blood and effusion in small quantities (from 100 to 300 ml) is not detected by x-ray examination. Pneumothorax develops in every third victim.

Signs of closed pneumothorax: general condition of moderate severity, high blood pressure, moderate tachycardia, shortness of breath, percussion - box sound, auscultation - weakened breathing, subcutaneous emphysema, signs of acute respiratory failure. The X-ray shows collapse of part or all of the lung.

The rapid development of pulmonary heart failure indicates tension valvular pneumothorax.

Treatment: emergency pleural puncture in the second or third intercostal space along the midclavicular line, drainage of the pleural cavity through underwater drainage.

Indications for thoracotomy: pronounced release of air from the pleural cavity through the drainage for more than 48 hours (a sign of rupture of a large bronchus). Injuries to the internal organs of the chest were detected in 71.6% of victims, including damage to the lungs - in 51.4%, damage to the heart (bruises) - in 18.6%,

Lung damage in case of multiple fractures, they most often have the character of marginal ruptures or bruises of areas of various sizes, which are clinically manifested by pneumothorax, the development of subcutaneous emphysema, pulmonary hemorrhage through the upper respiratory tract, hemoptysis, increased breathing, the appearance of acrocyanosis, and chest pain. During an X-ray examination, multiple small-spotted shadows may be visible in the lungs, reflecting hemorrhages in the lung tissue.

Later, after 4-5 days, limited infiltration of lung tissue may appear in certain areas or throughout the entire pulmonary field, sometimes the clinical picture of a lung contusion during fluoroscopy corresponds to the picture of pneumonia.

In rare cases, a local hematoma forms, which presents known difficulties for differential diagnosis with a lung tumor.

Damage to the diaphragm difficult to diagnose clinically, especially with severe multiple injuries. Be sure to carry out X-ray examination. Physical symptoms depend on the timing of the start of the examination after the injury, the presence of concomitant injuries, as well as the degree of prolapse of internal organs through a rupture of the diaphragm. Pulling the lung upward with limited mobility may result in the development of insufficiency external respiration. Shift of the mediastinum to the opposite side can lead to the development of heart failure.

As a rule, when the left dome of the diaphragm ruptures, the stomach and intestines prolapse into the pleural cavity, which is easily detected by fluoroscopy; if the diaphragm is damaged on the right, liver prolapse is not always detected.

Diagnosis can be aided by artificial pneumoperitoneum, in which air moves through a ruptured diaphragm from the abdominal cavity into the pleural cavity.

Aortic damage It is rare among victims in the clinic, since they mostly die at the scene of the incident. Modern achievements Thoracic surgery allows us to hope for the possibility of saving such victims with timely diagnosis and surgery. The classic site of aortic rupture in chest trauma is the area of its arch immediately after the origin of the left subclavian artery.

The clinical picture of aortic damage is very characteristic. According to the mechanism of injury, it should be expected with a combination of fractures of the spine and ribs, as well as with an impact or compression of the chest in the anteroposterior direction with the formation of multiple fractures of the ribs in the cartilaginous part on the left.

Early symptoms: short-term loss of consciousness, arterial hypotension, dysphagia, hoarseness (pressure of the hematoma on the main bronchi, esophagus and recurrent laryngeal nerve), systolic murmur on the aorta, widening of the shadow of the upper part of the mediastinum on the radiograph.

Mechanism heart injuries more often associated with compression of the chest or a strong direct blow to the sternum. As a result of a direct blow or counter-impact, myocardial bruises with hemorrhages, ruptures of muscle fibers, epicardium and pericardium occur.

The damage is most often diffuse in nature, and its typical localization is the wall of the left ventricle. With a heart attack-like form of cardiac contusion, death can occur in the coming hours and days, regardless of other damage. Even with a favorable course, developing myocardial sclerosis disrupts the activity of the heart, significantly complicating the life of victims after injury. The angina form of heart contusion is more favorable, however, even with this form pathological process may progress to chronic coronary insufficiency and the development of dystrophic cardiosclerosis.

The clinical picture is characterized by persistent tachycardia, extrasystole, arterial hypotension with low pulse pressure, shortness of breath, cyanosis, moderate expansion of relative cardiac dullness, weakening of the first heart sound, the appearance of a pericardial friction noise, and systolic murmur at the apex of the heart.

The electrocardiogram reflects myocardial hypoxia and coronary insufficiency, typical of myocardial infarction.

Mortality reaches 60-70%. A harbinger of cardiac arrest is bradycardia.

Trauma to the organs of the upper abdominal cavity and retroperitoneum with multiple fractures of the ribs, it is almost natural, since these organs (liver, spleen, kidneys, adrenal glands) are located within the lower ribs, are protected by them and are injured almost as often as the organs of the chest cavity.

Damage liver observed in 2.9% of victims (almost every second of them dies within the first 2 hours after injury from massive blood loss).

Damage spleen observed in 1.3% of victims. In polytrauma, splenic ruptures are easy to miss and in almost 30% of cases the diagnosis is made only at autopsy. In conditions of polytrauma, the greatest diagnostic value in case of splenic rupture are signs of increasing blood loss (with the exclusion of other possible sources), determination free liquid(blood) in the abdominal cavity using percussion, positive result laparocentesis, presence of rib fractures above the spleen, x-ray examination. Diagnosis of intra-abdominal bleeding, based only on physical examination data in the presence of cranial coma, alcohol intoxication, drug use, multiple fractures of the lower ribs, retroperitoneal hematoma, is very difficult, which can lead to unnecessary or delayed laparotomy. Novocaine blockade of bone damage can help identify damage to the internal organs of the abdomen. The possibility of “deep” palpation of the abdomen after the blockade eliminates damage to the abdominal organs and avoids laparotomy.

Injury kidney determined in 6.9% of patients. The most important symptom of kidney damage is hematuria (up to 20 red blood cells in the field of view), which lasts 2-3 days in victims with kidney bruises, with ruptures of the capsule and cracks of the kidneys (up to 50-60 red blood cells in the field of view) - for 7-9 days.

Chromocystoscopy and excretory urography may be useful to determine the side of the injury and the presence of kidney blockage or ureteral avulsion.

Urological examination can be carried out on victims only after they have been brought out of shock.

Penetrating chest wounds are extremely dangerous. Accompanied by damage to internal organs, they threaten severe disruption of basic life functions (respiration and circulation). The danger of these injuries is aggravated by the apparent well-being and insignificance of clinical signs.

An initially relatively satisfactory general condition with a small wound may deteriorate sharply in the following hours and result in death.

All wounded must be hospitalized. More often than other organs, the lungs are damaged, then the heart, diaphragm, large vessels, trachea, and esophagus. High mortality at the site of injury and during transportation indicates the danger of every penetrating wound.

Closed pneumothorax is formed due to the penetration of air into the pleural cavity from a lung wound. In case of tension pneumothorax, air is removed from the pleural cavity by puncture of the chest wall and valve drainage. With subcutaneous emphysema, if it does not increase or become tense, no urgent intervention is required, with the exception of mediastinal emphysema, which can significantly impede the functioning of the heart.

In case of open pneumothorax, the wound must be immediately closed with a sterile sealing bandage that extends far beyond the edges of the wound. To prevent the bandage from slipping, it is recommended to simultaneously bandage the arm on the sore side. Then it is necessary to clear the upper respiratory tract, inhale oxygen and administer cardiac drugs. For pain relief, non-narcotic analgesics, promedol, and vagosympathetic blockade according to Vishnevsky are used.

Internal bleeding if the heart and large vessels are damaged, it is dangerous due to blood loss and the possibility of cardiac tamponade. Immediate puncture of the pericardium can save the life of the wounded person for the time required to transport him to the hospital (Fig. 2).

Rice. 2.

Traumatology and orthopedics. N. V. Kornilov

During accidents, not only external injuries are possible, which are diagnosed by the sight of a wound or an unnatural position of the limb, but also injuries to internal organs, which pose a threat to the life of the victim due to the difficulty in diagnosing them. Sometimes they can only be diagnosed after a significant period of time has passed after the injury.

Injuries often cause ruptures of internal organs, accompanied by severe internal bleeding. This occurs if internal organs that contain large amounts of blood, such as the liver, kidneys or spleen, are damaged. However, there are also injuries in which, as a result of the blow, severe tissue damage occurs, cells die, and the organ cannot function normally.

Symptoms

Strong pain.
Tense anterior abdominal wall.
Feeling of fullness in the stomach.
Hemoptysis.
Symptoms of shock.

The organs of the chest or abdomen can be injured by a sharp or blunt object during a traffic accident, for example, when a driver hits the steering wheel with his chest or stomach, or when a person falls on his chest or back. In addition, gunshot or puncture wounds are possible.

Treatment

If internal organs are injured, the patient requires urgent medical attention. It is necessary to resort to intensive care measures as quickly as possible. Typically, such patients have to be urgently operated on to stop internal bleeding. In addition, only during surgery can the doctor carefully examine and accurately determine the extent of damage to the internal organs. Stopping bleeding depends on the degree of damage and its location; for example, damaged blood vessels may be cauterized with electrocautery, tightened, or sutured with threads.

Stop bleeding

Bleeding (if the wound area is large) can be stopped with medication, such as fibrin glue, or cauterization using electricity. If the tissues are so severely damaged that they are not capable of regeneration, then the organ must be urgently removed, without waiting for tissue death (necrosis) and poisoning of the entire body with decay products. When internal organs are damaged, the patient almost always has to be injected by drip canned blood and resort to measures to stabilize blood circulation. In addition, it is extremely important to ensure the vital functions of the body (breathing, heart function).

First aid for internal injuries

The first aid provider can put the victim’s body in a “jackknife” position (put the victim on his back with his legs slightly elevated). If the patient is excited and frightened, then it is necessary to try to calm him down. If the lungs are damaged, the patient should be placed on his back so that the upper body is slightly elevated. All other therapeutic measures can only be applied by a doctor.

If you have pain in the abdomen or chest and the slightest suspicion of damage to the thoracic or abdominal organs after an accident, you should immediately consult a doctor. If you have symptoms of shock, you should immediately call an ambulance. Symptoms of shock may include paleness, cold sweat, rapid heartbeat, and shallow, shallow breathing. A fairly important symptom of internal organ injuries is severe pain. The presence of damage to the abdominal organs can also be assumed by the tense anterior abdominal wall. If the lungs are damaged, the victim vomits or coughs up foamy, light-colored blood. With gastric bleeding, the patient feels fullness in the stomach and nausea.

Having learned the circumstances of the incident and assessed the symptoms of the injury, the doctor will make a diagnosis and resort to appropriate treatment measures.

If emergency surgery is necessary, the doctor tries to take all necessary measures to save the damaged organ. However, during a subsequent reoperation, the dead parts of the organ often have to be removed.

In most cases, bruising of an internal organ occurs due to a blow with a blunt object. But it could also be:

injury sustained during sports(rugby, martial arts, football);
consequence of an accident. Since the passenger is usually positioned sideways to the vehicle, it is the rib, liver and thigh that are affected;
a fall . As a rule, a fall from a great height (at least 2-3 meters) leads to a liver bruise. But there are cases where the injury was even caused by a person slipping on ice;
sudden rise in weight;
pinching between two objects. For example, these could be elevator or bus doors.

Depending on the nature of the damage, there are:

liver hematoma. This is an accumulation of blood in the liver area, which is limited to the muscle layers;
ruptures - subcapsular (when hemorrhage occurs under the capsule) and transcapsular (when the fibrous membrane of the liver is disrupted).

Depending on the external manifestations and the formation of other symptoms associated with the well-being and general condition of the patient, narrower criteria are identified that conditionally divide liver injuries into several categories.

Depending on the cause of blood in the abdominal cavity:

Bile duct injuries.
Vessels passing inside the liver.
Vessels located outside the liver.

Depending on whether injuries occurred in the internal area or with violations of the integrity of the fibrous membrane, injuries are divided into two groups.

If the fibrous membrane of the abdominal organ has not been damaged, injuries are divided into categories:

bleeding is located under the liver capsule;
hematomas and bleeding form in central region organ.

If the fibrous membrane of the abdominal organ is damaged, injuries are divided into categories:

formation of one or more cracks;
crushed liver;
division of the organ into functionally inferior segments;
formation of large damage to the bile ducts;
gallbladder damage;
damage to the gallbladder and biliary system of an individual nature (without injuries to the liver segment).

Signs that appear in the first hours after injury indicate the degree and severity of the injury, since, in addition to classification by location, injuries are divided according to the strength of the injury:

closed injuries of an internal organ, the depth of which does not exceed 2 cm;
the depth of damage reaches half of the entire thickness of the organ;
the depth of damage exceeds half the thickness of the organ;
there is a division of the liver into fragments due to multiple ruptures in a person.

A timely visit by an injured patient to a medical facility for examination or calling an ambulance is the most important stage in recovery and even saving a person’s life. Injuries in the abdominal area are especially dangerous due to the lack of protective skeletal structures and the presence of large blood vessels.

Trauma code according to ICD 10

ICD 10 is an international classification of infectious diseases, injuries and congenital pathologies human body. The latest changes to the classification characteristics were made in 2016.

According to ICD 10, liver injuries belong to the block “Injury of the abdominal organs (S36)”, and has its own section “S36.1 - Injury to the liver or gallbladder”.

The following types of bruises of internal organs are possible (the second name is blunt trauma to the abdomen or blunt trauma to the chest):

without violating the integrity of a parenchymal or hollow organ, as a rule, hemorrhage develops into the organ;

In medicine, it is customary to determine the severity of injury in degrees, starting from the first, the mildest degree, and up to the most serious, the fourth.

There are several types of bruises. Some of them pass quickly, some slowly. Each bruise requires special treatment. So, depending on the location, bruises are of the following types:

without violating the integrity of the parenchymal or hollow organ; as a rule, hemorrhage into the organ develops;
with a violation of integrity, including tears of the capsule, ruptures of the parenchyma, crushing in severe cases.

Causes

The human body is a very delicate and fragile mechanism, which makes many factors acting from the outside world detrimental to health and general condition of people. Thus, liver contusion is possible as an independent phenomenon, and as an accompanying injury.

Causes of liver contusion:

impact when falling;
a blow to the abdomen with a blunt object (a blow to the abdomen without external damage to the skin);
squeezing a person's body between two objects;
excessive tension in the abdominal muscles in infants;
lifting heavy weights;
rib fracture;
internal disorders of the organ structure and liver diseases.

When, due to damage, hematomas (bruises) of various sizes form on the liver and neighboring tissues, such manifestations are associated with injury to the blood vessels and functional parts of the internal organ.

Diseases of the musculoskeletal system (musculoskeletal system) provoke the development of bone fragility; skeletal diseases are a common cause of disruption of the integrity of internal organs during fractures.

Bruised ribs develop in a person after a chest injury. The causes of damage can be various:

carelessness while playing sports;
fall damage;
traffic accident;
fight.

The cause of a bruise is most often a fall or a blow. The impact occurs with a blunt object, so the skin is not torn, but it is the soft tissue that suffers. It is important that the blow first falls on one place. And then the blood begins to spread further. Tissue compaction and hematoma may occur.

Treatment

As we have already said, the concept of bruise can apply to any part of the human body and to any organ, which determines the further actions of medical personnel. Depending on which organ was damaged to the maximum extent, the issue is decided with the specialized department where such a patient should be observed (meaning severe degrees that pose a threat to life).

Next, we will look at bruises of various organs or parts of the body, and the first aid that, if possible, should be provided to the victim before admission to a qualified or highly specialized medical institution.

When the patient is taken to the emergency room, the doctor examines the color of the skin and measures blood pressure and temperature. Then he performs a thorough palpation of the abdominal cavity. The final stage in making a diagnosis is ultrasound. It will show the location of the hematoma and its size.

X-rays are often also ordered. The picture shows: if the contours are clear, then everything is in order. If the diaphragm is displaced, the colon and stomach are deformed, and the contours of the liver are blurred, there is a high probability of a hematoma.

One of the diagnostic options is laparoscopy. The procedure is carried out under anesthesia: a small incision is made in the abdominal cavity, through which an endoscope is inserted.

Depending on the severity of the injury, the doctor chooses one of three rehabilitation methods:

surgery. Prolonged bleeding can only be stopped by surgery. IN medical practice Ligation of damaged vessels and suturing of small cracks are widely used. In cases where an organ has been severely damaged, we will talk about its resection (partial removal);
drug treatment. If there is no serious blood loss, the doctor will prescribe conservative treatment using hemostatic, healing and cleansing drugs. It is possible to prescribe physiotherapeutic procedures that will accelerate the restoration of soft tissues: magnetic therapy, UHF, electrophoresis;
physiological recovery. If the damage is very minor and there is no internal bruising, the doctor may simply order rest at home and bed rest for a few days. Will not interfere vitamin complexes and hepatoprotectors.

In a hospital setting, after liver surgery, a blood transfusion or reinfusion (infusion of your own, but filtered) blood is often prescribed. It is also necessary to follow a strict diet with the exclusion of alcohol, fatty and fried foods, sweets, and citrus fruits.

Treatment folk remedies if the liver is bruised, it only aggravates the problem. After all, every hour counts! And the longer the victim self-medicates, the less likely it is that doctors will be able to return him to a full life.

First medical aid after injury is an important step in preserving the life and health of the victim.

It often happens that after receiving a liver injury, the patient is in a state of severe painful shock, or unconscious - in this case, the first step is to return the patient to consciousness.

What to do if you have a liver injury:

Lay the victim down so that it is comfortable, but without putting pressure on the abdomen.
Apply cold to the bruised area.
Use anesthetic injections (you cannot take medications or liquids orally, as they can increase the load in the abdominal area).
After receiving an injury, blood begins to accumulate in the victim’s abdominal cavity, so to provide assistance and diagnose possible ruptures, it is necessary to call an ambulance or take the patient to a medical facility.

Hospitalization is necessary due to the use of an oxygen mask and other means of resuscitation. In case of a delay that lasts several days (depending on the severity of the injury, the time is reduced), the victim may be fatal.

Liver contusion and gallbladder damage are diagnosed in a medical facility using:

ultrasound examination (ultrasound);
computed tomography;
laparoscopy.

Treatment for liver contusion is determined after identifying the extent of damage.

After diagnosis, the doctor prescribes a treatment method:

Intravenous administration fluids into the body.
Pain relief.
Surgery is being performed. During severe closed liver injuries, bleeding into the abdominal cavity is likely; in this case, surgical bleeding is stopped and, in some cases, even a section of the organ is removed. Reinfusion is performed (transfusion of the patient's own purified blood).
Therapy with medicines(including taking antibiotics).
Rehabilitation course (observation at a dispensary for a month).

Indications for surgical intervention include:

formation of a closed injury with severe bleeding;
development of anemia within 3 days after injury;
hemobolia;
biligemia;
liver abscess;
separation of a segment of an internal organ.

Monitoring the patient’s condition in a hospital setting allows for quick assistance in the event of complications developing in the later stages of rehabilitation.

In conditions
first aid is only possible
temporary or preliminary stop
bleeding for the period required
to deliver the victim to a medical facility
institution.

For
emergency arterial arrest
bleeding method is widely used
pressing the arteries throughout. This
the method is based on the fact that a number of arteries
easily accessible to palpation and blood flow
according to them, it is possible that a number of arteries are easily
accessible for palpation and blood flow through
it can be completely blocked
pressing them to the underlying bone
formations.

Methods
temporary stop of bleeding:
pressing a bleeding vessel (with
using a bandage, fingers, bending
knee and pressing it to the stomach, compression
limbs with a tourniquet, application of a regular
or pressure bandage, etc. Compressed
the bandage quickly thromboses the vessels.

At
the patient has a nosebleed
plant, put an ice pack
(cold) on the back of the head and on the nose and pinch both
half of the nose. If this doesn't help, then
perform tamponade of the nasal passages (passage)
bandage soaked in hydrogen peroxide.

Gastrointestinal
bleeding can be reduced by creating
rest the patient by placing him on his back. On
you need to put an ice pack on your stomach,
completely prohibit the intake of food and liquids
and organize its delivery to a medical facility
institution.

Violation
integrity of skin, tissues and
organs as a result of mechanical
impacts are called damage
or wounds. Most common damage
caused by direct action
mechanical force (impact, compression,
stretching, etc.) on body tissue.

Mechanical damage can be
closed and open. Most often
when playing sports they meet
closed injuries (bruises, sprains,
subcutaneous ruptures of soft tissue-muscles,
tendons, blood vessels, etc.).

If you have all the symptoms of a abdominal bruise, you should definitely go to the doctor. Neither the victim’s relatives nor the patient himself correctly diagnoses the lesions and prescribes treatment, especially if the resulting abdominal injury is serious.

Before the ambulance arrives, for minor bruises, pre-medical first aid is provided for abdominal bruises. It is allowed only in case of blunt closed injuries.

The affected person is given the following measures to relieve symptoms:

Without any sudden movements, place the victim on level ground;
Hold the patient so that he does not lose consciousness;
Apply cold to the damaged area to relieve tension and acute pain.

As a cooling compress, you can take a heating pad and pour cold water, or just a piece of cloth soaked in ice water. You need to apply cold for 10 or 20 minutes, then take a break for five minutes, and repeat the procedure again.

In total, first aid should not last more than two and a half hours. If the measures taken do not alleviate the patient’s condition, then only doctors can eliminate the negative feelings. Bleeding, pallor of the patient, loss of consciousness and increasing pain - these are the symptoms that only emergency specialists can do.

After a blow or bruise, it is forbidden to give the patient food, painkillers or water.

First aid for a bruised abdomen is very important, because before the doctors arrive, the hematoma of the internal organs grows and complicates an already difficult situation.

In order for a traumatologist to tell how to treat a rib bruise, he must diagnose the bruise, and not more serious injuries. The doctor conducts an initial examination, where he visually assesses the integrity of the bones, the size of the hematoma, and the condition of the skin.

Based on the examination results, the doctor prescribes the most effective therapy. Treatment for a rib bruise depends on the specific situation (symptoms and severity of injury).

Treatment with medications involves the use of analgesics and drugs (most often ointments) with an analgesic effect. In case of hyperemia, antipyretic drugs are prescribed.
Breathing exercises develop injured ribs and relieve aching pain.
Physiotherapy is recommended after the patient's condition has improved slightly. It helps restore natural body movements. Physiotherapeutic procedures include: electrophoresis, ultra-high frequency therapy, as well as heating with a blue lamp or electric heating pad.

When a rib or several ribs are bruised, the following symptoms appear:

pain, discomfort, which may intensify when inhaling;
pain when palpating damaged ribs;
the rib hurts when moving, in particular when turning the body;
swelling of the skin, hematoma over the area of damaged ribs.

With a bruise, the same symptoms develop as with a crack and fracture. Therefore, it is important to accurately diagnose the pathology. For an accurate diagnosis, it is necessary to undergo a chest x-ray examination.

It is not difficult to identify bruised ribs, but to rule out a fracture and damage to internal organs, an X-ray examination will be needed. It allows the doctor to assess the condition of the bones and their integrity, and see damage to internal organs.

Before starting treatment, the doctor collects an anamnesis of the disease. How should this be done?

Find out how the injury was caused. First, the doctor questions the patient. He finds out how the patient received bruised ribs. If a person is injured due to an attack, it is important to know the force of the blow. He fell - he must remember from what height.

Examination of the patient. The doctor must conduct an examination; palpation is needed from both the back and chest. He needs to make sure that there are no extraneous noises in the lungs or heart.

Perform an x-ray or fluoroscopy of the chest. It is done in two projections: lateral and direct. This is mandatory, because Before starting to treat a patient, the doctor must make sure that there are no rib fractures. At first, it can be difficult even for a specialist to make a diagnosis, because if the fracture was not displaced, the symptoms are very similar.

Additional examination to distinguish rib bruises from fractures. It is not always possible to send the patient for an X-ray examination. What to do in this situation? Eat special technique, with the help of which a bruise and a fracture are distinguished.

The doctor should press on the chest from the sides and front. If it is a rib fracture, the patient will feel severe pain in this area. With bruises there is no such pain.

After this, the doctor may tap your chest. If there was a fracture, the patient will begin to cough and produce sputum containing blood. These symptoms indicate that the lung is affected. When they are not present during examination, we are talking about a bruise.

The primary differential diagnosis of rib bruises is carried out taking into account the patient’s condition and examination data. To definitively exclude severe injuries, a chest x-ray is prescribed.

With lung contusions, foci of darkening are detected that do not coincide with the boundaries of the lobes and segments; ribbon-like stripes of darkening may appear along the course of some bronchi. With hemothorax, a clearly visible, contrasting homogeneous darkening with a horizontal upper border appears in the lower sections.

With pneumothorax, the pulmonary pattern in the areas of collapse of the lung is absent, the shadow of the mediastinum is shifted to the healthy side, and sometimes layers of air are visible under the skin. In doubtful cases, in addition to radiography, an MRI of the lungs may be prescribed, which allows identifying small areas of lung collapse, small foci of hemorrhage, etc. In case of cardiac dysfunction, a cardiologist is invited for consultation; in case of severe respiratory disorders– pulmonologist or chest surgeon.

If there are no pathological manifestations of the ribs and internal organs, a diagnosis of rib bruise is made.

If you feel that you have a lot of pain in the bruised area around the ribs, you need to make the correct diagnosis as quickly as possible. They will help you with this modern methods diagnostics that make it easy to distinguish a fracture from a bruise. The main ones are X-ray examination and ultrasound.

But when you come to your appointment, the doctor will first conduct a preliminary examination, ask you exactly where it hurts and examine the site of the suspected injury. Sometimes, due to similar symptoms, it can be difficult to distinguish between a fracture and a bruise, so you will have to visit an x-ray office.

An X-ray or ultrasound examination will allow you to prescribe correct treatment, in which you can quickly return to your normal lifestyle.

Due to the high degree of pain experienced when a rib is bruised, this damage can hardly be neglected. In addition to visual inspection of the integrity of the ribs, the manifestation of uncharacteristic bulges and dents in the chest area, there are humane, effective methods diagnostics These are:

X-ray examination of the chest organs in its different projections will give a holistic picture of the condition of the ribs and internal organs;
computed tomography - will determine the presence of any defects in the affected area;
MRI – will project the condition of both the ribs and internal organs in all planes and sections.

Indications from an X-ray examination are needed to obtain a general picture of anxiety, and for a more detailed examination, computed tomography and magnetic resonance imaging are prescribed.

In case of complicated injuries, additional diagnostics of internal organs are prescribed, from measuring the heart rate to ultrasound. Timely diagnosis will save you from serious injury and death.

Important if you experience persistent, acute pain in the ribs, when breathing, coughing, or any physical activity and rest, consult a specialist. A routine examination by a doctor will benefit your recovery.

First aid

To reduce pain and avoid complications, you need to know what to do immediately after an injury.

Examine the area of the injury and make sure there are no dents or bulges. If they are present, you need to urgently consult a doctor; rib fractures are possible.
Maintain bed rest. Limit physical activity; sudden movements in case of bruised ribs are strictly prohibited.
Take painkillers for severe pain. For example, Ibuprofen or Diclofenac.
Lie on the injured side. This will make breathing easier.
Apply cold to the damaged area. It will reduce pain and swelling. First, apply a pressure bandage to the ribs, then cover it with moistened cold water with a towel or an ice pack.

If after an injury you experience dizziness, coughing up blood, poor coordination of movements, or a change in heart rate, you should urgently seek medical help.

Occupational therapy

The doctor prescribes treatment depending on the severity of the injury and symptoms:

Drug treatment: the use of analgesics and pain-relieving ointments; if the temperature rises, antipyretic drugs are prescribed.
Breathing exercises will help relieve bruised ribs and get rid of aching pain.
Physiotherapeutic procedures are prescribed after the patient’s condition improves and will return him to his usual physical activity.
UHF, amplipulse, electrophoresis, electric heating pad and blue lamp.

Folk remedies

Treatment for bruises involves relieving tension in the affected area. This needs to be done first.

Various cooling compresses are used for this purpose. Then medications can be used in the form of gels and ointments, as well as folk remedies, which contain exclusively natural ingredients.

Let's consider each treatment method separately.

Medicines

As noted earlier, you first need to apply something cold to the sore spot, for example, ice, frozen meat, and so on. Be sure to wrap it in a towel so as not to get frostbite in addition to the bruise. It is advisable to apply cooling compresses for no more than 15 minutes.

Local agents produced in the form of gels or ointments, for example, Indomethacin, are also often used. The recovery period is a special time during which the patient must follow a gentle regimen.

During the first 2-3 days, it is not advisable to get out of bed at all, unless, of course, the damage was severe. Try to avoid intense loads and sudden movements if you are seriously injured, as this will only aggravate the situation and the recovery period will be greatly delayed.

If your close person He was injured and needs help. What to do?

It is advisable to immediately take him to the hospital so that the doctor can make a diagnosis and prescribe treatment.

Of course, only a doctor can give a final diagnosis, but some signs will help suspect a fracture:

elements of the ribs protrude from under the skin;
strong bulges and dents appear on the chest;
the ribs “crunch” a little when inhaling and exhaling;
The pain after the injury is very strong.

If all these symptoms are present, it is necessary to take the victim to a doctor as quickly as possible in order to begin treatment as soon as possible.

The victim should be given an analgesic, cold should be applied to the area of injury - this will help reduce swelling, hemorrhages and hematomas. Even if the patient’s condition is satisfactory and there are no signs of severe chest injuries, it is necessary to urgently transport the patient to the emergency room or trauma hospital, since initial stages Severe injuries may be asymptomatic.

It is better to carry out delivery in a sitting or semi-sitting position - this will help the victim breathe easier.

Chest bandaging should be used with caution, only in case of severe pain and for a short time, since the bandage not only reduces pain, but also limits chest excursion.

This entails deterioration of lung ventilation and increases the likelihood of developing post-traumatic bronchitis and pneumonia, especially in older people and patients suffering from diseases of the respiratory system.

For intense pain, analgesics are prescribed. Patients are referred for UHF and then for electrophoresis.

It is advised to perform breathing exercises to prevent hypoventilation. For coughs, expectorants with a bronchodilator effect are prescribed.

Repeated examinations are carried out regularly to detect complications in a timely manner. For long-term non-absorbing soft tissue hematomas, opening and drainage are performed.

Recovery usually occurs within 1 month.

Many people are interested in the question, how long does treatment last? In general, recovery from damage is successful and there are no side effects. However, it is impossible to say exactly how long rehabilitation will last.

It depends on the nature of the injury and individual characteristics body. It is necessary to treat the disease at home for as long as possible until the symptoms of the injury pass and the person regains full mobility.

On average, therapy lasts 2–3 weeks.

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In order for a rib fracture or bruise to quickly become just an unpleasant memory for you, you must strictly follow all the specialist’s recommendations. If there is only a bruise, follow these procedures:

Applying a cold compress or ice bottle to the injury site will help reduce swelling and reduce pain.
There is no need to do anything in such a situation: you only need peace and bed rest. Otherwise, you will have to treat the bruise for quite a long time, and the pain will not leave you for several weeks.
Try to reduce the severity of the discomfort by using an ointment with an anti-inflammatory and analgesic effect.

If you have a rib fracture that is very painful, traumatologists usually resort to local anesthesia easing the patient's condition. It should only be done in a hospital setting.

A fixative bandage is required only for multiple serious rib injuries. Also, a special approach is required for pneumothorax and hemothorax.

Conservative treatment, for example, the use of ointment, is ineffective, so a specialist performs a puncture to remove blood or air from the pleural cavity.

Treatment of a bruise should be immediate; severe bruises require special attention. Basically, the physical pain of bruised ribs is unbearable.

Therefore, every effort is made to reduce the painful discomfort of any movements. Injuries are accompanied by contusions, hematomas, bruises, cracks and fractures.

In these cases, all efforts are aimed at reducing swelling, redness, and pain in the damaged area. Much more difficult cases with a fracture of a rib or even several ribs.

In such a situation, it is necessary to rigidly fix the position of the rib. This is possible with the help of various corsets, but sometimes a tight bandage of the chest is used, which is fraught with consequences.

Treating a rib bruise on your own is life-threatening. Professional therapy is very important in this case.

Treatment is used depending on the severity of the injury. Thus, both inpatient and outpatient treatment of patients is possible.

After receiving x-ray images and clarifying the general picture of the disease, the traumatologist prescribes appropriate treatment. The use of drug treatment is accompanied by a number of physiotherapeutic procedures and gymnastics.

For example, all medicinal efforts are aimed at eliminating painful breathing and body mobility. Painkillers, anti-inflammatory, antipyretic, decongestant drugs are used, both in the form of tablets and various syrups and ointments.

These could be:

paracetamol;
ibuprofen;
heparin;
voltaren emulgel;
other tablets and pain-relieving ointments.

If there are cracks or fractures of the ribs, physiotherapeutic procedures are prescribed in the form of electrophoresis, UHF therapy and amplipulse therapy, as well as an electric heating pad.

Electrophoresis as a method of physiotherapy is quite relevant in this case, as it can strengthen the body’s protective functions and deliver medications to hard-to-reach places.

Ultrahigh frequency therapy has anti-inflammatory and analgesic effects. It can have a beneficial effect on tissue restoration and increases the body's protective functions.

Amplipulse therapy is prescribed for a deep effect on tissue, reducing swelling and pain in the affected area of the body, as well as restoring normal blood supply. An electric heating pad is also used for this, but only at the final stage of recovery.

In addition to all medical prescriptions, it is important to maintain physical calm and bed rest. Reducing physical activity will reduce pain and prevent possible risks of complications.

Wearing additional corsets or tight bandaging should only be done by a specialist who can professionally assess the tension force and the required degree of fixation of the rib position.

You should refrain from active movement or any physical activity, especially in the first days of the injury. An exception is therapeutic exercises to restore the muscle corset thoracic, stretch marks.

Gradual, uniform physical activity promotes a quick return to the normal rhythm of life.

To avoid the formation of bone adhesions, it is necessary to follow the intended therapy. These formations cause both external aesthetic defects and internal pleurisy.

Traditional methods of treatment should not be neglected. You should remember the compatibility of some medications with herbs, carefully read the package insert, and consult your doctor.

The first independent aid consists of cooling the damaged area of the body and reducing physical activity. It should be remembered that not all bruises are accompanied by hematomas and bruises.

It all depends on the severity of the blow in the event of defeat. Particular attention should be paid to bruises in the area of the heart and lungs in order to prevent damage to internal organs and further development of diseases.

Possible complications include pneumonia, the development of infectious diseases, prolonged pain, oxygen starvation, accumulation of air and blood in the pleural zone.

To protect yourself from the possible development of complications, you should urgently visit a traumatologist, undergo diagnostics and begin therapy. It is necessary to carefully study the instructions for the drug, as some cause excessive drowsiness and digestive disturbances.

Compliance with all medical prescriptions, the complex effect of medications with physiotherapy, and then with physical gymnastics, traditional medicine can speed up the healing process of the body.

You can treat a rib bruise yourself using home remedies only if the bruise is minor. If the bruise is severe, then you cannot do without a traumatologist. To alleviate your condition before visiting a doctor, you need to know what to do if you bruise your ribs.

Examine the bruised side for bulges and dents;
Take the most comfortable position and do not move;
To ease breathing, lie on your injured side;
Take a pain reliever;
Instead of a pillow, make a cushion out of dense material and place it under your head;
Lubricate the injury site with absorbable ointment or cream with a similar effect;
Bandage the chest with an elastic bandage;
Apply something cold to the ribs (on a pressure bandage).

In the presence of dizziness, confusion (incoherent thinking, usually combined with decreased attention and disorientation), coughing up blood, weakness, heart pain, changes in heartbeat and others important symptoms, you need to see a doctor as soon as possible.

Treatment of damage must begin with first aid. The person should be at rest and not move. A tight bandage must be applied to the chest. Cold is applied to the damaged area: ice, snow, a bottle of cold water, or simply make compresses soaked in cold water cloth.

The patient needs to have an x-ray taken to make sure there are no rib fractures. Only after this can you begin to treat the bruise.

Treatment for bruises at home

Treatment can be carried out at home. For the treatment of bruised ribs, drugs are used traditional medicine. Products for external use promote blood flow to the site of injury and speedy recovery after injury. With their use, the bruise will go away faster.

It is necessary to make applications with folk remedies daily. Compresses are best done in the evening before bed.

Bandages with leaves of medicinal plants are left for the whole day, the leaves themselves are changed twice a day. It is best to treat the injury with various folk remedies; in this case, the therapy will be more effective and the symptoms will go away faster.

Bruise is considered the most common type of all injuries and occurs most often in everyday conditions due to elementary human negligence.

With such an injury, only the external and internal soft tissues (skin, blood vessels, nerve endings, muscles, subcutaneous tissue and ligaments) are damaged; this is the main difference between a bruise and a fracture.

A very common case in medical practice and statistics is a back bruise.

The results of medical research have confirmed that women, the elderly, athletes and overly active children are most often exposed to severe back bruises.

Classification

There are several types of spinal injuries:

with existing spinal cord damage;
without compromising the integrity of the spinal cord;
with injury to internal and external soft tissues;
without the formation of wounds;
accompanied by vertebral dislocation;
with a violation of the integrity of the vertebral bones.

As you know, no person is immune from injuries. In terms of severity, a back bruise after a fall is considered one of the mildest injuries.

However, the consequences of this injury can be quite serious.

A back bruise is rightfully considered one of the most dangerous injuries, because this injury is associated with extensive bruising of soft tissues.

One of the most dangerous injuries is a back injury. Mechanical shock, accidents, accidents, falls, impacts on the surface of the water are the main causes of back injuries.

This type occupies a special place in the list of injuries due to the severity of the consequences. After a fall, soft tissues, muscles, and the spinal cord are often damaged.

Treatment and its duration depend on the area that is most affected and the severity of the injury. Much of the treatment is determined by the patient’s compliance with all medical recommendations.

Degree of damage: what you need to prepare for

A bruise in any part of the back can result in the most unpleasant consequences for health, as evidenced by several special sections formed in ICD-10 ( International classification diseases of the 10th revision), where each type of injury is assigned a separate code.

ICD-10 describes symptoms and additional characteristics of the condition in relation to each department, providing first aid medical care and systemic treatment. Therefore, when determining the severity of injury cervical region, lower back, level of damage to soft or bone tissue, specialists are guided by ICD-10.

Back contusion is considered in class S00-T98, where for each type of open and closed injury a code is indicated, recommendations and prognosis are given.

If internal organs are injured, the patient requires urgent medical attention. It is necessary to resort to intensive care measures as quickly as possible.

Typically, such patients have to be urgently operated on to stop internal bleeding. In addition, only during surgery can the doctor carefully examine and accurately determine the extent of damage to the internal organs.

Stopping bleeding depends on the degree of damage and its location; for example, damaged blood vessels may be cauterized with electrocautery, tightened, or sutured with threads.

Stop bleeding

In case of damage to internal organs, the patient almost always has to be injected with canned blood and resort to measures to stabilize blood circulation. In addition, it is extremely important to ensure the vital functions of the body (breathing, heart function).

First aid for internal injuries

If the lungs are damaged, the patient should be placed on his back so that the upper body is slightly elevated. All other therapeutic measures can only be applied by a doctor.

In the absence of indications for surgical treatment, bruises of internal organs are treated conservatively. The basic principles of treatment are as follows:

meals are carried out in fractions, but often; plant foods and fiber are recommended, eliminating constipation; the prescription of laxatives is indicated;

We treat GASTRITIS, ulcers, colitis at home. FOREVER! To cure the STOMACH, you need...

A bruise can happen anywhere, and doctors cannot follow you around day and night. In this case, first aid is applied. The rules for providing first aid are quite simple, but they must be followed strictly.

Firstly, if the bruise is severe, it is worth immobilizing the place and taking the victim to the hospital, where he will have an x-ray. The same should be done if there are signs of a concussion (bruises under the eyes, nausea and vomiting, dizziness, nosebleeds), for which any unprofessional assistance can be fatal.

Secondly, you should apply something cold to the damaged area; this will help reduce swelling and pain by constricting blood vessels. Usually a pressure bandage is applied for these purposes, but if you know very little about it, it’s not worth it - it can cause harm.

In such cases, a simple bubble or ice pack, special cooling spray, or snow from the street will work well.

It is worth reminding the patient or yourself that now any hot baths or massage are contraindicated and prohibited for 3-4 days. If a wound or abrasion occurs during an impact, it should be washed with running water and hydrogen peroxide, and then treated with brilliant green or iodine, but only in cases where the wound is small.

For large injuries, such assistance can cause severe pain shock. To reduce pain, you can take a painkiller, such as aspirin.

When first aid has been provided, the patient should be taken to the emergency room, where he will be injected with anti-tetanus serum and the bruise will be examined and correctly diagnosed, because similar symptoms are also typical for serious injuries.

After all the measures, it is worth providing the patient with complete bed rest; doctors should apply a bandage to the injured limb, limiting its mobility.

There are many types of bruises, and after first aid, which is the same for everyone, begins traditional treatment, varying for different injuries. When a finger is bruised, it is mandatory to take painkillers; sometimes sedatives are also used, especially if this injury occurs in a child.

If such a bruise is not serious, the patient is usually sent home with some anti-inflammatory ointment prescribed. When the hematoma and pain begin to subside little by little, you need to stretch your finger without causing yourself pain.

A joint bruise is quite dangerous and therefore it is often treated under the supervision of specialists. In order to relieve pain, use camphor oil, bruise ointment and other means.

In such cases, fixing bandages are necessarily applied, and physiotherapy, therapeutic exercises and magnetic therapy are also prescribed, which eliminate the possibility of complications.

When a face is bruised, nothing other than first aid is usually used. It's another matter if it is accompanied by a bruised nose. With it, for 2 days, every 2 hours you need to apply cold compresses for a quarter of a minute. After this, the cold is replaced by warmth, for example, warm sand in a bag or a heating pad is applied to the nose. At the same time, physiotherapy is prescribed.

Sometimes appointed vasoconstrictor drops, especially if your nose is stuffy. If the hematoma does not go away, this means that the blood is stagnating inside, and in this case it is removed artificially. Even with mild, first degree, bed rest is observed for at least 7 days.

Bruises of internal organs require immediate hospitalization. The treatment regimen for such bruises is quite complex and poorly understood. ordinary people, also varies for different organs.

Any help from a non-doctor in such cases means an unforgivable delay, because these bruises often entail internal bleeding that is invisible to the naked eye, which will kill the victim.

Sometimes alternative medicine is just as good and fights a bruise in time. But it is worth remembering: all folk methods and remedies are used only after and together with the treatment regimen prescribed by the doctor.

Very often, bruises are treated with self-prepared ointments. For this method you need to take:

75 g freshly picked burdock roots, washed and dried;
200 ml olive or sunflower oil.

The use of ointments is based on their proven effectiveness, as well as on the fact that these are external preparations that have local help, which means their harmful effects on the body are minimal.

Common types of bruises are knee joint bruise and contusion elbow joint and shoulder...

These types of bruises are not severe. Often found in children who are busy active species sports: running, cycling, skiing, etc. In most cases, the outcomes are favorable - complete recovery.

Knee injury: what to do?

First of all, main symptom- this is pain in the place where you hit. After a few hours, subcutaneous hemorrhages appear, and hematoma and edema form.

The size of the bruise may not reflect the degree of soft tissue contusion. In older people, with a minor blow, a huge bruise and thickening immediately appear, since the body is no longer as strong as before: fragility of blood vessels and slower thrombus formation are observed.

The doctor first examines the area where the blow occurred. Then, depending on the type, x-rays may be ordered. If there is a suspicion that a certain organ has been damaged, then an ultrasound is prescribed.

If there is a suspicion that it was the abdomen that was injured, then the patient needs to undergo a blood, urine, and urine amylase test. In addition to ultrasound and x-rays, tomography may be prescribed. Ultrasound helps quickly and painlessly determine whether a person needs surgery. It shows the presence of bleeding and damage.

Laparoscopy may also be used. An endoscope is inserted through a small incision. This procedure allows you to determine the presence of bleeding and make a conclusion about whether to perform surgery or not.

Every person needs to know what to do if they are bruised. First you need to apply an ice compress to the bruise.

This will help reduce blood flow to the area and reduce compaction, resulting in a smaller bruise in the future. Ice is applied for 15-20 minutes several times a day.

Do not put ice directly on the skin; place any cloth under it. Otherwise you may get frostbite.

If the bruise causes pain, you need to take paracetamol. After the swelling subsides, you can move on to warm compresses.

They are applied for 10 minutes no more than 3 times a day. This is necessary to relax the muscles and allow blood to drain faster.

Treatment of bruises can be carried out using massage, which will stimulate circulatory system. An ordinary hematoma resolves in 7-10 days.

But there are also more serious bruises. In such situations, a person needs to call an ambulance and provide first aid.

Treatment of eye bruises

If you bruise your eye, you should immediately consult an ophthalmologist. When a person is hospitalized, he needs to limit eye movement as much as possible and not move his neck and head in different directions.

He is also not allowed to lift weights. After the blow, the eye must be covered with a sterile bandage, which is attached to the head with gauze.

The doctor will independently diagnose and prescribe treatment for bruises.

Help with bruises of internal organs

Everyone knows how to provide assistance for bruises, but not everyone knows how to provide assistance for bruises correctly. First aid for a bruise is to examine the damaged area, if it is a limb, then check its functions (flexion-extension, other movements).

If there are only symptoms of a bruise, and not a more serious injury, it is necessary to apply cold to the injured area. This causes spasm of the microvasculature and helps stop internal hemorrhage.

It is better not to use painkillers so as not to miss the deterioration of the condition in case of additional complications. However, if you are sure that the bruise has not damaged the internal organs, you can give an anesthetic drug, with the exception of aspirin (acetylsalicylic acid).

Aspirin should not be used to treat bruises, as it increases bleeding.

If there is a severe bruise of the head with loss of consciousness, a severe bruise of the lower back, abdomen or chest, in addition to applying a cold compress, the victim must be laid down and called an ambulance, or taken to the emergency room on your own, trying, if possible, to immobilize the bruised area and maintain peace.

It must be remembered that cold is effective only during the first thirty minutes. Then the necessary help for a bruise consists of giving rest to the bruised area.

Two days after the injury, gentle heat is required on the damaged area. Applying a warm compress during this period ensures blood flow to the site of the bruise, which accelerates the resorption of the hematoma without the risk of renewed bleeding.

Treatment of bruises is required when a significant injury occurs. Contusions to the head, abdomen, lower back and chest require hospitalization surgery department, where, after appropriate diagnostics, a decision is made on further treatment of the bruise.

In severe cases, surgical treatment of the bruise is performed. Access to the damaged area is carried out either endoscopically or openly, ruptures of large vessels, ruptures of parenchymal organs are sutured, and spilled blood is removed.

Then the wound is drained. In parallel, anti-inflammatory and painkillers are prescribed.

Treatment of a bruise in the regeneration stage consists of the use of physiotherapy in order to accelerate the resorption of the hematoma and the speedy restoration of damaged tissues.

Video from YouTube on the topic of the article:

on the first day it is possible to use cold, in the form of an ice pack;
it is necessary to provide rest to the affected organ;
pain relief is carried out only with the complete exclusion of peritonitis and the development of intestinal obstruction;
according to indications, infusions are carried out with drugs that improve blood clotting (Vikasol, Aminocaproic acid);
meals are given in small portions, but often; plant foods and fiber are recommended to prevent constipation; the use of laxatives is indicated;
in the subacute period, the use of physiotherapeutic procedures is recommended.

A traumatologist diagnoses bruised ribs, bruised arms or bruised tailbones externally, but after examination he must check the integrity of the internal organs and the absence of fractures. This is especially important in case of brain contusion.

Often, a victim may mistake a fracture for a bruise, this especially often happens when the ribs or shoulder are bruised. In this case, the patient does not treat the fracture, which can lead to complications.

Only a doctor should treat blows and injuries, with the exception of rare, mild forms. Even with such simple injuries as a bruised chest, bruised tailbone and bruised knee, hand or shoulder, neglect of the problem can lead to serious consequences. A fracture is often confused with a regular bruised toe, which can result in complications for the victim.

Treatment begins with an examination. If the elbow, hand or little finger, as well as other limbs are bruised, the absence of a fracture is checked, that is, the function of the limb.

After the signs of injury have been eliminated and the bruise has resolved, the consequences need to be treated with special ointments, compresses and gymnastics. A bruised heel, a bruised nose, and even a bruised tailbone or hand will not lead to serious consequences, however, they must be treated as carefully as eye and brain injuries.

Symptoms

The symptoms of the disease can vary significantly depending on which organ is affected. But the main signs of damage are:

Severe pain in the area of injury;
The appearance of a hematoma (most often it is of impressive size);
Edema. In most cases, it indicates the presence of internal hemorrhage;
Deterioration in the functioning of the affected organ.

Very often, with such a lesion, patients also suffer from nausea and low blood pressure.

Since the nerve endings in the liver area are unevenly distributed, pain syndrome It can be either very pronounced or practically absent. In most cases, local pain is observed at the site of injury, incl.

hours from damage to deep muscles.

The discomfort may spread to the lumbar and groin area. Doctors often notice the patient's difficulty breathing, tension during palpation, Kulenkampf's symptom, increased blood pressure and skin abrasions.

Liver bruise is characterized by noticeable symptoms, the identification of which allows you to save a person’s life.

Severe and sharp pain when injured

What symptoms indicate that the patient has a bruised rib? How to understand what to do?

Main symptoms

If the following symptoms appear after an injury, you should visit a doctor:

Strong pain.
Tense anterior abdominal wall.
Feeling of fullness in the stomach.
Hemoptysis.
Symptoms of shock.

When spontaneous pneumothorax or pulmonary contusion occurs, acute respiratory failure develops. Along with cyanosis, pallor, cyanosis of the skin, the patient’s anxiety increases, and a drop in blood pressure is possible.

Most often, lung bruises occur when hitting the steering wheel, as well as falling on a hard surface.

Consequences of a bruise

Regardless of which internal organ was damaged, immediately after the injury it is necessary to see a doctor, who, after conducting a diagnosis, will identify what the patient is faced with.

In approximately 40% of cases, lesions of this kind require surgery. If hemorrhage or tissue rupture is not repaired in time, the consequences for the patient can be dire, even death.

Liver contusion has serious consequences if treatment rules are not followed or assistance is not provided in a timely manner.

Possible complications:

Tissue necrosis, sepsis.
Hemobilia, biligemia.
Development of an abscess (suppuration in the area of the hematoma).
Cyst formation in liver tissue.
Subphrenic abscess.
Liver failure, intrahepatic abscess, bleeding of liver vessels.
Bleeding in the first 3 days after surgery or diagnosis.
Fibrinolysis.
Peritonitis.
Decreased mobility of the diaphragm dome in the right area.
Changes in the position of the colon and stomach.

Serious consequences can also be caused by home treatment and reluctance to contact a specialist. It is important to remember that complications from a liver contusion must be treated immediately after the first signs appear, otherwise death is possible.

A liver injury does not provoke the development of cancer.

After bruises in the abdominal area, treatment is often prescribed by a surgeon. For a correct diagnosis, the patient will be asked to undergo an x-ray and a blood test. ultrasound machine, computer tomography or laparoscopy.

This is done to determine whether the patient needs surgical intervention. A less serious injury may require bed rest, cold treatment, or physical therapy to eliminate swelling, bruises and abrasions.

Do not forget that complications may develop later after an abdominal injury. One of the most common is a hernia formed after a muscle rupture. Most dangerous consequence The injury leaves internal bleeding. It is always considered as a direct threat to the patient’s life.

Complications such as peritonitis are common after surgery. This inflammation can cause blood poisoning and can be fatal for the patient.

In the vast majority of cases, slight and even severe bruises pass without consequences, or the consequences of the bruise disappear without a trace within two to three weeks. However, there are situations when the consequences of a bruise can be quite serious.

First of all, this applies to the already mentioned head contusions. The fact is that the skull is a closed space, and the hematoma, which in any other place of the body would resolve over time without causing significant concern, in the skull leads to compression of vital brain structures.

In this case, the consequence of a bruise can be neurological disorders of varying severity and localization, severe headache accompanied by nausea and vomiting, and even death.

One of the consequences of a bruise, although quite rare, can be the calcification of a hematoma. In this case, a compaction remains in the soft tissues, which can cause quite significant pain when moving.

In some cases, the long-term consequence of bruising the soft tissue of the mammary gland in women or the testicle in men may be the development malignant tumor these organs.

A serious consequence of a bruise is a violation of the integrity of a large vessel. In this case, significant hemorrhage and even internal bleeding is possible, the formation of a blood clot is possible, followed by a serious complication - thromboembolism, when blood clot with the movement of blood, a vessel of smaller diameter enters and blocks it.

Thromboembolism can lead to heart attack, stroke, necrosis of an internal organ, and death.

Also of significant danger are the consequences of bruises of internal organs, for example, bruise of the heart, bruise of the kidneys, liver, spleen. In this case, various damages and disruptions of their functions are possible, which pose a danger to life.

Considering all of the above, do not underestimate bruises, especially serious ones.

A brain contusion is a consequence of a traumatic brain injury that damages brain tissue. If a bruised toe or hand causes only external consequences, then everything is much more serious.

Brain contusion is a serious problem that requires special treatment and monitoring. Unlike, for example, a bruised finger, such an injury can lead to serious consequences.

Preventive measures

The first preventive method for severe pain in the ribs is to limit a person’s physical activity. Then you should undergo certain physiotherapeutic procedures.

It would not be superfluous to purchase a fixing rib in the form of a special vest. It is important not only to wear such a design, but also to install it correctly.

This will reduce physical stress on sore ribs.

Do not ignore the increase in body temperature and manifestations allergic reactions, since these phenomena indicate the development inflammatory process in organism.

For treatment, use various painkillers and anti-inflammatory ointments. They are excellent as a preventive measure, and besides, you can purchase such drugs not only with a doctor’s prescription, but also without it.

Trauma to the chest, and in particular to the ribs, does not pose a serious danger to human health and quite rarely leads to serious complications.

But incorrect or inattentive treatment of a bruise is another step towards unpleasant consequences for the patient’s health. Do not ignore such injuries.

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The following types of bruises of internal organs are possible (the second name is blunt trauma to the abdomen or blunt trauma to the chest):

without violating the integrity of the parenchymal or hollow organ; as a rule, hemorrhage into the organ develops;
with a violation of integrity, including tears of the capsule, ruptures of the parenchyma, crushing in severe cases.

Based on localization, internal organ trauma is divided into blunt trauma of an isolated area (thoracic, abdominal) and combined trauma, which has signs of damage in two areas (polytrauma). Based on the involvement of anatomical structures and organs of damage, bruises are differentiated into:

bruised lung (one or two);
heart bruise; in severe cases, traumatic myocardial infarction may develop;
liver bruise;
bruised spleen;
bruise of the kidney, bladder;
bruise of the hollow organs of the abdominal cavity: stomach and intestines.

A breast bruise in women stands somewhat apart. The incidence of these injuries has increased significantly due to the increase in the number of female car drivers.

Symptoms of contusion of the internal organs of the chest and abdominal cavity

Common complaints with lung contusions include chest pain, shortness of breath, and possibly hemoptysis. In case of rib fractures, there is severe pain when breathing, which can be relieved with novocaine blockades. When spontaneous pneumothorax or pulmonary contusion occurs, acute respiratory failure develops. Along with cyanosis, pallor, cyanosis of the skin, the patient’s anxiety increases, and a drop in blood pressure is possible. Most often, lung bruises occur when hitting the steering wheel, as well as falling on a hard surface.

Internal injury rate lung organs and moderate severity increases in winter time due to an increase in the frequency of domestic injuries. With bruises of the abdominal organs, patients mainly complain of pain, nausea or vomiting, and a feeling of weakness. An important period is the period of “imaginary well-being”, which is characteristic of intestinal rupture with spillage of contents into the abdominal cavity. It can last for several hours; Often this time is missed, which leads to the development of peritonitis.

If parenchymal organs are damaged - the liver or spleen - pain is most often localized in the right or left hypochondrium, respectively. Of the retroperitoneal organs, kidney bruise is the most common. The most common symptom indicating injury is massive hematuria. Fresh blood may indicate injury to the bladder or underlying urinary tract. If symptoms of jaundice appear 2 to 3 days after the injury, a liver contusion may be suspected.

Diagnosis of internal organ damage

Currently, due to the possibility of X-ray computed tomography, the indications for diagnostic laparotomy have been significantly narrowed. MRI has a much more limited use (despite its greater information content) due to the longer study time. Usually done diagnostic laparoscopy in a “clean operating room” with the possibility of moving to laparotomy and performing surgery. Indications for laparoscopy:

reliable signs of internal bleeding into the abdominal cavity (except for the terminal state);
obvious abdominal wounds (including lacerations, cuts, stabs and gunshots) with extended revision;
unclear and blurred clinical picture with severe alcohol intoxication and the inability to conduct a full-fledged instrumental study;
signs of developing peritonitis as a consequence of intestinal rupture: an increase in pain that becomes diffuse in nature, increased local and general tension in the muscles of the abdominal wall up to a plank-like state;
an increase in signs of acute cardiovascular failure, which indirectly indicates internal bleeding or rupture of a large parenchymal organ: the appearance of a thread-like pulse, tachycardia, pallor, cold skin, especially in combination with psychomotor agitation, the development of oligoanuria;
progressive bloating and lack of abdominal breathing, participation in the respiratory act only of the chest;
the complete absence of peristaltic bowel sounds in the first hours indicates bleeding, in late dates(on days 2–3) – about the development of intestinal obstruction.

If, in the presence of the above symptoms, surgical treatment is carried out in a timely manner, this allows one to avoid delayed purulent-septic and thrombotic complications.

Conservative treatment of bruises of internal organs

In the absence of indications for surgical treatment, bruises of internal organs are treated conservatively. The basic principles of treatment are as follows:

on the first day it is possible to use cold, in the form of an ice pack;
it is necessary to provide rest to the affected organ;
pain relief is carried out only with the complete exclusion of peritonitis and the development of intestinal obstruction;
according to indications, infusions are carried out with drugs that improve blood clotting (Vikasol, Aminocaproic acid);
meals are given in small portions, but often; plant foods and fiber are recommended to prevent constipation; the use of laxatives is indicated;
in the subacute period, the use of physiotherapeutic procedures is recommended.

Symptoms of bruises of internal organs Basic methods of treating bruises of internal organs

Injuries associated with mechanical impact on the human body are the most common in medical practice. The main reasons for their appearance:

Impact with a blunt object. Colliding with a very hard object (usually found in road accidents). Fall from a great height.

Symptoms of bruises of internal organs

The nature of the damage resulting from bruises depends primarily on the degree of mechanical load and on the area of the body to which this load was directed. For example, if we are talking about a chest contusion, it is possible pathological changes in the lungs, heart, trachea, etc. If the main mechanical load falls on the abdominal area, the stomach, spleen, liver, kidneys, etc. may be significantly damaged. A head injury is often accompanied by a brain contusion, the consequences of which can be extremely serious. However, signs of a concussion are a topic for another discussion. How to recognize bruises of internal organs in other cases?

The main symptoms that allow us to draw conclusions about a bruise of internal organs:

Severe pain in the damaged area. The presence of a hematoma in this area. Swelling of soft tissues in the damaged area. This condition is usually caused by internal hemorrhage. Impaired functionality of the organ that was affected.

Manifestations may vary depending on which organ was affected. In general, external signs of bruises to internal organs can be described as follows:

Growing subcutaneous emphysema (excessive accumulation of air in the tissues, accompanied by severe pain). If the lungs are damaged, cyanosis (bluish coloration of the skin) and respiratory distress are observed. Decline blood pressure, decreased heart rate. Injuries to organs located in the abdominal cavity are often manifested by a feeling of fullness in the stomach and nausea. Hemoptysis.

If the kidneys, liver, or spleen are damaged, internal bleeding can be very severe. Any injury that causes injury to internal organs requires professional medical attention.

Basic methods of treating bruises of internal organs

First aid for suspected bruises of internal organs due to a fall is to ensure the victim’s rest. It is also necessary to take emergency measures:

Apply ice or a cold compress to the injured area. To avoid anaphylactic shock, the patient must take a pain reliever. In some cases, a tight bandage is indicated (for example, with a closed chest injury).

Severe bruise of internal organs following an accident requires immediate hospitalization. In a hospital setting, a thorough diagnosis is carried out, which helps to identify the size and area of distribution of damage to internal organs. The main diagnostic method is x-ray, and in case of a brain injury, computed tomography or magnetic resonance imaging (MRI) may be required. In case of a chest bruise, the doctor will prescribe an ECG - an electrocardiogram, the interpretation of which will help to obtain a more objective picture of the disease.

Treatment usually comes down to surgery, which is carried out to stop internal bleeding and restore the integrity of the damaged organ. If the injury was not severe, to eliminate the hematoma 3-4 days after the injury, you can rub the damaged area with ointments that have an anti-inflammatory effect (without the warming effect).

Strong blows to the abdomen, chest, lumbar region, perineum, especially if they are accompanied by fractures of the ribs, sternum, pelvic bones, can lead to damage to the heart, lungs, liver, spleen, intestines, kidneys, and bladder.

Heart damage. Several factors are involved in the mechanism of heart damage in blunt chest injuries:

1) direct physical impact on an organ with hemorrhage in its parts - myocardium, subendocardium or epicardium;

2) the influence of the central nervous system on the endocrine-vegetative regulation of heart activity (stress);

3) various metabolic disorders in the myocardium (redistribution of catecholamines, potassium, sodium, etc.), which lead to hypoxia and hypotension;

4) hyperfunction of the sympathoadrenal system, as a result of which the cardiotoxic effect of catecholamines increases.

There are four degrees (forms) of closed heart injury:

Shake — most light form closed heart injury. It is characterized by the rapid development of short-term and mild clinical-cardiographic changes. Victims complain of aching, quickly passing pain in the heart area

The main symptom is arrhythmias (paroxysms of tachycardia, atrial fibrillation, atrial or ventricular extrasystoles), as well as conduction disturbances up to complete, albeit transient, transverse block of the heart or one of the legs of the atrioventricular bundle (bundle of His) Characteristic dizziness, fainting, short-term

At heart bruise subtle, non-penetrating myocardial ruptures are observed (the atria are affected more often than the ventricles), which can be accompanied by extensive hemorrhages involving subepicardial areas and the thickness of the myocardium. Sometimes they compress small branches of the coronary arteries, which leads to the formation of subsequent

common scar-altered areas. Often all the membranes of the heart become saturated with blood. In this case, the myocardium becomes flabby and unevenly saturated.

Characteristic constant or paroxysmal pain in the heart area, arrhythmias, expansion of the heart in diameter, shortness of breath, various changes on the ECG. In severe cases, heart failure develops.

Traumatic heart rupture — the most severe form of its closed injury Traumatic myocardial ruptures - common reason deaths: they are observed in 10-15% of all those killed in car accidents

Ruptures of the right ventricle of the heart occur less frequently than the left; in 30% of the damage they are multi-chamber in nature; in UZ patients, pericardial ruptures simultaneously occur; in the rest, the pericardium remains unaffected, but there is a threat of cardiac tamponade with blood, and subsequently, with a favorable outcome, — development of pericarditis.

Cases of ruptures of traumatic aortic aneurysms, characterized by high mortality, have been described.

The consequence of a closed heart injury can also be pericarditis (inflammation of the pericardium) , coronary thrombosis and traumatic myocardial infarction, “dislocation of the heart” and its “compression”, traumatic heart hole, arrhythmias, myocardial dystrophy.

Damage to the pleura and lungs occur with bruises of the chest, its compression, fractures of the ribs and sternum, wounds from fencing weapons and athletics spears. IN closed damage pleura (without breaking the skin) the main role usually belongs to the end of the broken rib.

Lung contusion. For pulmonary contusion caused by closed injury chest, characteristic clinical picture of hemorrhage in the lung, which is usually asymptomatic: hemoptysis, especially in the first 3-5 days, chest pain, apparently associated with damage to the pleura, shortness of breath and decreased breathing in the corresponding area of the lung, short-term fever, moderate increase in the number of leukocytes in blood and a slight acceleration of sedimentation

Due to the short duration of the changes (5-7 days), the most informative is an X-ray examination performed on the first day after the injury.

When pneumonia is added, there is an increase in symptoms, as well as a longer and higher increase in temperature, a pronounced increase in the number of leukocytes in the blood and the appearance of young forms.

When a lung is contused, hemothorax often develops - blood entering the pleural cavity, the clinical manifestations of which depend on the degree of blood loss, displacement of the mediastinum and compression of the lung by accumulated blood, the degree of destruction of the lung tissue and reduction pulmonary ventilation. The development of hemothorax may be accompanied by acute pulmonary heart failure.

At severe injury with multiple rib fractures There is a progressive development of respiratory failure caused by limited respiratory excursions and ineffective cough.

One of the most severe and early complications of thoracic injury is traumatic pleurisy. As a rule, it occurs within the first three days after injury. The effusion usually corresponds to the side of the injury, but may be bilateral or contralateral. Characteristic complaints of pain when breathing in the chest and shortness of breath.

Pneumothorax — the presence of air or gas in the pleural cavity. The entry of air into the pleural cavity inevitably leads to partial or complete collapse of the lung.

Depending on the cause of occurrence, traumatic, spontaneous (spontaneous) and artificial (therapeutic) pneumothorax are distinguished.

At open pneumothorax the pleural cavity communicates with the external environment through a gaping defect in the chest wall or bronchus.

The pressure in the pleural cavity is equal to atmospheric pressure (for small defects, it decreases slightly when inhaling and increases when exhaling). The lung completely collapses and is switched off from the act of breathing. The most severe phenomena arise due to the fact that the opposite lung, which in that case provides all gas exchange, begins to function under abnormal conditions. The negative pressure in the healthy pleural cavity cannot be balanced by the pliable and easily displaceable mediastinum, which is under

influenced by atmospheric pressure, it shifts towards the healthy lung, as a result of which the functional capacity of the latter is significantly reduced. Since the pressure in the intact pleural cavity fluctuates significantly during the respiratory phases, and on the side where the open pneumothorax occurred remains approximately constant, with each inspiration the displacement of the mediastinum increases, and with exhalation it decreases. As a result, the mediastinum

together with the vital organs contained in it, abundantly supplied with nerve receptors, undergoes more or less sharp fluctuations, “runs”. This leads to difficulty in blood flow through the vessels of the mediastinum and primarily through the vena cava, disruption of the heart and the occurrence of severe shockogenic reactions

At closed pneumothorax there is no communication between the air in the pleural cavity and the external environment.

In the pleural cavity, one or another level of negative pressure is usually maintained, at least at the moment of inspiration. In connection with this, the collapse of the lung on the damaged side is often incomplete. It partially takes part in gas exchange. The mediastinum shifts slightly and its fluctuations are expressed to a small extent. Respiratory and circulatory disorders with closed pneumothorax are much less pronounced than with open pneumothorax, and are quickly compensated after a short period of disturbances that are largely reflexive in nature (irritation of the pleura by infiltrated air)

Severe disturbances occur with valvular pneumothorax, usually observed with small defects of the chest wall, lung tissue or bronchus. With this type of pneumothorax atmospheric air at the moment of inhalation, it is sucked into the pleural cavity, and during exhalation, when the pressure in the pleural cavity increases, the defect is covered and does not allow air to pass in the opposite direction. In some cases, air enters the pleural cavity during the exhalation phase.

The amount of air in the pleural cavity gradually increases, the lung collapses and is switched off from the act of breathing, and the mediastinum shifts to the healthy side, as a result of which severe respiratory and circulatory disorders can occur.

Urgent Care. At open pneumothorax(chest injury) first aid consists of applying a sealed bandage, at least temporarily converting an open pneumothorax into a closed one and reducing mediastinal oscillations. Without such a bandage, death can occur even before the ambulance arrives. The simplest hermetic bandage consists of several layers of gauze, heavily soaked in Vaseline, over which compress paper or oilcloth is applied. After applying a sealed bandage, urgent delivery of the victim to a special medical facility is necessary.

Closed pneumothorax, as a rule, does not require the use of urgent medical manipulations if there is no significant displacement of the mediastinum. However, even with a closed pneumothorax, the patient must be taken to the hospital.

At valvular pneumothorax it is necessary to deliver the patient as quickly as possible to a medical institution, where he will receive emergency care (unloading the pleural cavity from excess air using a puncture, i.e. inserting a special needle into the pleural cavity, in order to convert the valve pneumothorax into an open one).

Damage to abdominal organs may occur during an impact in the hypochondrium area (with a football boot, a throwing projectile, when hitting surrounding objects, etc.), a fall from a great height (during diving) and due to the counter-impact mechanism against the spine and ribs (when jumping by ski). They are accompanied by symptoms of shock, expressed to varying degrees. Characteristic rapidly increasing internal bleeding (especially with ruptures of the parenchyma and capsule of the liver and spleen), pallor of the skin and mucous membranes, threadlike pulse, confusion or loss of consciousness, sharp tension in the muscles of the abdominal wall. When the intestines are damaged, inflammation of the peritoneum develops - peritonitis.

Urgent Care.

Traumatic injuries to the spleen account for 20 to 30% of all parenchymal organ injuries.

There are one-stage and two-stage ruptures of the spleen.

With single-stage ruptures, simultaneous damage to the parenchyma and capsule occurs. In these cases, bleeding into the free abdominal cavity from the ruptured spleen occurs immediately after the injury.

With a two-stage rupture, usually at the first moment only one parenchyma of the spleen is injured with the formation of a subcapsular hematoma. When repeated, often under the influence of a minor apparent reason, the capsule ruptures and the hematoma breaks into the free abdominal cavity. Between the moment of injury and the breakthrough of blood into the free abdominal cavity, a certain period of time passes, calculated from several hours to several weeks and even months.

The clinical picture of splenic injury varies depending on the severity of the injury, the time elapsed since the injury, and the presence of concomitant injuries to other organs. The leading symptoms are acute blood loss and shock, which are accompanied by signs of peritoneal irritation.

Typically, victims complain of pain in the left hypochondrium, less often in the upper abdomen or throughout the entire abdominal cavity. The pain often radiates to the left shoulder and left shoulder blade.

Irritation of the peritoneum by engorged blood leads to tension in the abdominal wall and severe pain on palpation.

Massive bleeding, in addition to local symptoms, characteristic of intra-abdominal bleeding, leads to the development of general manifestations of acute blood loss: rapidly progressing weakness of the victim, the appearance of tinnitus, dizziness, nausea, vomiting, cold sweat, pale skin, visible mucous membranes, etc. In severe cases, the patient may develop agitation, impaired consciousness and sharp drop blood pressure.

With the formation of an extensive subcapsular hematoma, stretching of the capsule with gushing blood causes significant pain and a feeling of fullness in the left hypochondrium.

The prognosis depends on the severity of the spleen injury, the amount of blood loss and the nature of concomitant damage to other organs. The timeliness of surgical intervention is of decisive importance for the outcome of the disease.

Urgent Care. Apply cold to the affected areas, rest and urgent hospitalization (usually surgery is necessary).

Damage to the kidneys and bladder possible with a blow to the lumbar region, abdomen (suprapubic region), or a fall from a height onto the buttocks. In the latter case, the kidneys suffer due to a blow to the spine and lower ribs.

Direct damage to the kidneys, which is accompanied by a bruise, is characterized by hemorrhages into the renal parenchyma, its edema and ischemia, vascular thrombosis and infarction, hematuria, and acute renal failure.

Kidney damage is accompanied by a state of shock, the appearance of blood in the urine or the formation of a perinephric hematoma. In this case, acute renal failure may develop.

Bladder rupture is accompanied by urinary retention, which quickly flows into the peri-vesical tissue. State of shock deepens by the phenomenon of intoxication.

Urgent Care. Apply cold to the affected areas, rest and urgent hospitalization (usually surgery is necessary).

Main signs of abdominal trauma

From the anamnesis, the mechanism of injury, the position and condition of the body at the time of injury, the direction and force of the blow, the state of the abdominal wall at the time of injury (muscle tension or relaxation), and the degree of filling are determined. gastrointestinal tract food and liquid preceding injury, and diseases of the abdominal organs. Subjectively, patients complain of pain, general weakness, nausea, and less commonly, vomiting. Pain sensations can be in the first hours without a specific localization, throughout the abdomen or with a predominance in the upper or lower sections. Often the pain is associated with rib fractures with concomitant chest injuries (after intercostal blockade with novocaine, these pains disappear). The diffuse nature of the pain is typical for rupture of the intestines, mesentery, intracavitary or retroperitoneal bleeding. Localization of pain in the right or left hypochondrium with irradiation to the shoulder of the same name is characteristic of damage to the liver and spleen.

The duration and intensity of pain are important in diagnosis. If the intensity of pain subsides 2-3 hours after the injury and the victim’s condition improves (hemodynamics and breathing normalize), then with a high degree of probability damage to internal organs can be excluded (in the absence of objective signs of internal bleeding and peritonitis). If the pain progressively increases and becomes diffuse, indications for laparotomy should be given (even in the absence of objective signs of intra-abdominal pathology). It should be remembered that with local damage to the intestines, patients can walk for a long time, seek medical help on their own, and feel quite satisfactory. However, gradually, intensifying every hour, their signs of peritonitis increase.

Signs of severe shock in the first 1.5-2 hours after injury indicate massive internal bleeding, the source of which is often a rupture of the spleen or liver. In this case, the pulse becomes thread-like, 130-140 beats per minute, sharp (dead) pallor of the skin and mucous membranes, a decrease in the temperature of the extremities, ears, nose, forehead are noted, and cold sweat appears. Psychomotor agitation (with low or uncertain pressure) confirms the diagnosis and serves as a formidable harbinger of the approaching death of the victim. Patients may complain of increasing tinnitus, dizziness, excruciating thirst, and lack of air. Their abdomen is swollen, moderately tense and painful. Only emergency surgery can save the patient.

One of the reliable signs of intra-abdominal damage is the absence of abdominal breathing (or, as they say, the stomach does not participate in the act of breathing). Another reliable sign is pronounced tension (rigidity) of the abdominal wall. The stronger this tension, the more likely the internal organ will rupture. With a sharp tension in the abdomen (“like a board”), an intra-abdominal catastrophe is beyond doubt. The absence of sounds of intestinal peristalsis (auscultation) in the first hours after injury indicates more intra-abdominal bleeding; in the later stages (2-3 days), the “deathly silence” of the abdomen indicates diffuse peritonitis. Symptoms of peritoneal irritation (Shchetkin-Blumberg symptom, etc.) are not specific to abdominal injuries, but they always indicate an acute irritant in the abdominal cavity. The combination of these symptoms with other objective and subjective data significantly increases the reliability of the diagnosis.

A common symptom of intra-abdominal injury is vomiting, in early period it is associated with irritation vagus nerve, in the later stage - with intoxication of the body. You should always be wary of the “vanka-stand up” symptom - the patient’s desire to return to the previous position after turning over on his back, other side, etc. This phenomenon is based on a sharp increase pain from irritation of new areas of the peritoneum by the spilled contents of the gastrointestinal tract or blood (even in small quantities). The appearance of dullness in the sloping areas of the abdomen indicates the presence of fluid in the abdominal cavity. This sign becomes clear when about 1 liter of liquid accumulates. If blood accumulates, then objective signs of massive blood loss must be determined at the same time. The reliability of the sign increases if the fluid boundary moves when the patient's position changes.

A simple but very informative diagnostic technique is bladder catheterization (especially with concomitant pelvic fractures). An overfilled bladder can obscure the clinical picture of damage to the abdominal organs, lack of urine can be the cause of intra-abdominal rupture of the bladder, and the presence of blood in the urine is a consequence of kidney damage.

A digital rectal examination can also be very informative. This is the only method of direct palpation of the peritoneum. Collection of blood or other fluid in the rectovesical recess in men or in the uterorectal recess in women can be directly palpated through the rectum and thereby definitively confirm the diagnosis.