外科-胸部外伤课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,THORACIC INJURY,General consideration(1),Physiological basis:,*Pleural cavities are the closed spaces,*Lung ventilation is accomplished by the,generation of,negative pressure,*,Negative pressure,:,During the quiet respiration,it varies from-6 to-12 cmH,2,O with inspiration to-3 to-5 cmH,2,O during expiration,General consideration(2),Anatomy basis:,*Pleura is divided into two portions:,Parietal,:,internal lining of the chest wall,Visceral,:,covering the entire surface of the lung,General consideration(3),Normal situation:,*The pleural cavities are to be closed space,*There are a little fluid accumulated not being seen,Abnormal situation:,Increased capillary hydro-pressure or great negative intra-pleural pressure,tends to increase transudation into the cavity,loss of intra-pleural negative pressure(pneumo-thorax)diminished transudation,General consideration(5),Mechanisms of thoracic injury,*blunt trauma(combined injury),*penetrating(local injury),Common causes,*,Peaceful time:,Automobile,industrial accidents,violent injury,*,Wartime:,missiles,gun shot,General consideration(6),The classification of thoracic injury,Closed thoracic injury:,*rib fracture,*pneumo-thorax,*hemo-thorax,*traumatic asphysia,et al.,Open thoracic injury:,*blind wound:triangle knife,stabbing injury.,*penetrating injury:gun shot,gun fire,General consideration(7),Thoraco-abdominal injury:,Chest injury below the 4,th,intercostal space,diaphragm,spleen,liver,colon and stomach may be wounded most often,Multiple combined injury:,Multiple system and more than three organs are involved in the trauma of chest,General consideration(9),Indication for thoracotomy,Uncontrolled hemorrhage,Massive and continuos air leak,Thoraco-abdominal injury with ruptured diaphragm,Cardiac or great vessels injury,Foreign body remain,Rupture of esophagus,Severe lung or air way laceration,Rib fracture(1),Special anatomy and injury,*The 1,st,to 3,rd,ribs are well protected by the scapulas and shoulder muscles,*The 4,th,to 7,th,ribs are most commonly injury involved because their length and location,*The 8,th,to 10,th,ribs are well elasticity for their cartilage connection with the sternum,*The last two(pseudo ribs)are free from anterior connection,Rib fracture(3),Pathology,Without significant internal involvement,The pleura and lung may be punctured or lacerated(pneumothorax,hemothorax,pulmonary or cardiac contusion,et al.),Flail chest wall(floating chest wall):,*The chest wall instability,paradoxical respiratory motion(suck in,push out),*Arterial blood gas test:PO,2,decreases and PCO,2,increases,Rib fracture(5),The management of the flail chest wall,The main project is to against the paradoxical respiratory movement of the chest wall,Methods:,pad,with bandage,external traction,appliance(3 to 5 Kg,1 to 2 weeks),internal stabilization,(positive pressure assisted ventilation after trachea intubation),PNEUMOTHORAX(1),The air leak from the organs within the pleural cavity:pneumo-thorax resulted,Classification,:,1.,Open(sucking)pneumo-thorax,Direct communication between the atmosphere and the pleural cavity,lung collapses,mediastinum shifts,obstruction of the blood return in the thoracic great vessels,severe cardio-respiratory dynamic disturbed,HEMOTHORAX(1),Hemorrhage into the pleural cavity space in some quantity in almost every patients,bleeding may be from any intra-thoracic,structure,Hemorrhage always coexists with,Pneumothorax,Early closed pleural cavity tubing drainage would prevent clotted hemorrhage,HEMOTHORAX(2),The criterion for thoracotomy,*more than 1000 ml blood in the cavity,*blood loss 100ml/hr.for 4 hours,*250ml/hr.for 3 hours,*Clotted hemothorax,early stage after thoracotomy,fibrous hemmorrhage,pleural decorticating procedure,TRAUMATIC HEART DISEASE(1),A lot of blunt or penetration injury of chest,the heart and great vessels in the pleural cavity may involved.The traumatic cardiovascular disease resulted,Any injury on the left anterior chest wall should be considered the heart injury,TRAUMATIC HEART DISEASE(2),Emergency treatment,life support management,Surgical procedure for stop bleeding,transportation to trauma care center,general thoracic injury management,Rehabilitation and physiology therapy,