9.1. Classification and diagnosis of chest trauma
Chest injuries may be classified as open or closed chest injuries, fractures of ribs, sternum, soft tissue injuries of the chest wall, lungs and large vessels of the mediastinum. Chest trauma is often accompanied by acute respiratory insufficiency, massive blood loss and shock. Among those who die of trauma, chest njury is detected in 50%; in 25% these injuries were the leading cause of death. Chest injuries can be open and closed. Open chest injuries include penetrating and non-penetrating chest wounds. Both open and closed chest injuries can cause bone fractures, injury to the lungs and mediastinal organs, hemothorax and pneumothorax.
The severity of respiratory insufficiency largely depends on the extent of chest trauma. If a normal respiratory rate is 16 per minute, a person with a slight degree of injury shows shortness of breath up to 25 per minute, at an average degree - 25-30 per minute, in severe cases - over 30 per minute.
Bruises of soft tissues of thoracic wall. This injury is does not usually tell on the victim's general condition. However, in case of extensive bruises, there is significant pain at respiration, and hemorrhage into soft tissues which may lead to respiratory disorders.
The diagnosis of soft thoracic tissue injury can be made only after ruling out injury to chest bones and organs of the chest.
Chest compression, traumatic asphyxia syndrome. Thoracic compression leads to increased intrathoracic pressure, which can result in injury of pulmonary parenchyma.
The vicitm's appearance is quite characteristic: in the head, neck, and upper torso the skin is distinctly bluish or bright red color. Bright red petechial or confluent haemorrhage is visible on mucous membranes. Victims complain of chest pain, progressive cough, shortness of breath, tinnitus, hoarseness. Respiratory distress and hypoxia-induced disturbance of consciousness are a possibility. Elevated BP is replaced by hypotension. Hemoptysis indicates lung involvement. Additional injury to the ribs, mediastinal organs, pneumoand hemothorax determine specific clinical manifestations and the severity of the victim's condition.