By Priv.-Doz. Dr. Werner Glinz (auth.)
Expanded wisdom concerning the pathophysiologic results of serious in juries, developments within the extensive care of sufferers of a number of accidents, and the remedy made attainable by means of modem cardiovascular surgical procedure make it look good to mix the overview and treatment of thoracic accidents right into a synthesis of varied branches of medication. This monograph, for this reason, is meant not just for the expert in thoracic or cardiac surgical procedure but in addition essentially for the individual that is the 1st to be faced via thoracic accidents, specifically, the final physician or the traumatologist. It displays my very own own event as leader medical professional of an emer gency surgical procedure ward of a school health center and as head of an inten sive care unit for the significantly wounded, which treats good over a hundred sufferers with critical thoracic accidents each year, and is predicated on an research of those situations. My event as an army health care professional in Vietnam was once additionally considered. Many wounds within the quarter of the thorax could be effectively taken care of with basic, conservative tactics, although via "conservative" i don't suggest to suggest "inactive." An competitive conservatism is desire ed, which needs to be aware of small information. In given situations, how ever, it calls for the fast decision-making potential of the com petent healthcare professional. therefore, enormous house is dedicated to questions of assessment and functional procedures.
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Additional resources for Chest Trauma: Diagnosis and Management
Only with evidence of respiratory failure is long-term mechanical ventilation unavoidable, unless it is one of the rare cases where surgical stabilization of the thoracic wall promises to be successful. Three-quarters of our patients with paradoxical respiration required mechanical ventilation. Even a satisfactory blood gas analysis does not take away from the fact that in multiple rib fractures the function of the lungs is restricted to a considerable degree. In the first few days after the accident, the vital capacity is reduced an average of 40% of normal (Fig.
14). Of the 23 patients with multiple rib fractures whom we tested daily during one full week for lung function, there were 3 patients with a forced vital capacity below 20% of normal (l3%, 16%, and 19%, respectively). In their cases adequate spontaneous respiration was possible. The vital capacity continues to drop slightly in the first 2 days after injury, then begins to slowly but steadily rise; as a rule, significant respiratory insufficiency seldom occurs after the critical 4-day peri04 following the accident.
A considerable increase in the right-to-left shunt is a characteristic feature of the pulmonary disturbances in ARDS and in atelectasis. The flow of venous blood from the right side of the circulation system to the left side of the heart, not coming into contact with any ventilated alveoli and hence not participating in the gas exchange, results in a mixing of venous blood with arterial blood and thereby causing arterial hypoxia. An increase in the oxygen concentration of the inspired air naturally has no effect upon the oxygen content of this venous blood admixture.