Closed chest trauma

Main characteristics of contusions and compressions

Various closed chest injuries are traditionally subdivided into chest wall contusions, compressions, and direct injuries to intrathoracic structures. The latter include traumatic changes in the lung tissue, bronchial ruptures, cardiac muscle contusions, and defects in major blood vessels.

The clinical presentation of contusions and compressions often corresponds to standard signs of closed soft tissue injuries. However, the pathological process may be accompanied by rib cage fractures, extensive hemorrhages into soft tissue structures, and vascular ruptures of the chest wall itself.

The physician must remember that the main danger in such conditions lies not in the external defect. The primary threat to the patient's life is posed by hidden internal organ injuries: severe trauma to the pleural layers and lungs, cardiac contusion, and ruptures of intrathoracic vessels, which can lead to massive internal hemorrhage.

Traumatic asphyxia syndrome

This life-threatening syndrome develops during extremely severe and sudden compression of the chest. This mechanism of injury is most typical of cave-ins, large-scale earthquakes, severe transport accidents, and accidental crushing of a person's torso between railway car buffers.

The pathogenesis of this condition is based on a simultaneous, powerful concussion and compression of organs located within the thoracic cavity, including the myocardium. Pathological changes develop rapidly, literally within the first moments after receiving the mechanical trauma.

Patients with traumatic asphyxia are always in an extremely critical condition. The clinical picture consists of the following manifestations:

• Respiratory function: pronounced dyspnea is observed, with respiratory excursions becoming very frequent yet shallow.
• Skin condition: cold, clammy sweat appears; the skin and visible mucous membranes acquire a marked pallor and cyanotic hue.
• Specific sign: formation of multiple punctate hemorrhages known as petechiae. They densely cover the skin of the chest, the conjunctiva of the eyes, and are also found on the surfaces of internal organs.
• Hemodynamic disorders: blood pressure drops significantly, while a rapid pulse of extremely weak volume is registered.

Pleural and pulmonary injuries and potential complications

Closed chest trauma causes a wide range of anatomical disruptions in the respiratory system. In clinical practice, the following potential types of injuries are distinguished:

1. Traumatic tracheal rupture.
2. Complete or partial avulsion of a main bronchus.
3. Rupture of the lung tissue itself.
4. Injury to the parietal pleura.
5. Injury to the mediastinal pleura. This condition is clinically significant because it inevitably leads to the development of pneumomediastinum.
6. Extensive injuries to chest wall structures.

If the trauma is accompanied by rupture of the pulmonary parenchyma or bronchi, air begins to enter the pleural cavity. This pathological process leads to the development of pneumothorax.

Another formidable complication of closed trauma is hemothorax—the accumulation of blood in the pleural cavity due to vascular rupture. In cases where intrapleural bleeding has stopped spontaneously, conservative management involves the evacuation of the accumulated blood. The primary method for fluid removal in such situations is therapeutic thoracentesis.

Class and exam questions

What else to study on this topic

• Pathophysiological mechanisms of pneumomediastinum development
• Differential diagnosis of various types of pneumothorax
• Surgical tactics for ongoing intrapleural hemorrhage
• Management specifics for patients with cardiac contusion

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.