Chair of the general surgery, children's surgery of medical faculty and
surgical illnesses of mediko-preventive faculty
The Tashkent Medical Academy
Lecture for students of a 3-course of mediko-preventive faculty on a
theme: Damages. A traumatism. The general reaction of an organism to a
trauma. Traumatic shock.
The lecturer: д.м.н., professor Ergashev U.J.
Composers: д.м.н., professor Ergashev U.J.
TASHKENT 2007
The lecture purpose:
1.
To Give concepts to students about damages and a traumatism.
2.
Will acquaint students the general reaction of an organism to a
trauma.
3.
Will explain to students патогенез developments and principles of
treatment of traumatic shock.
As the TRAUMA is called influence of external factors on a human body which
causes the anatomic in fabrics and bodies
And functional infringements.
Damaging agents happen:
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The mechanical
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The electric
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The thermal
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The chemical
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The beam
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The mental
CLASSIFICATION OF TRAUMAS:
By the form the factor caused traumas: mechanical,
Thermal, chemical, electric, beam,
Mental, operational, patrimonial, etc.
To external signs: opening (зияния skin and mucous
Covers) and closed, superficial and getting.
By the damaged part of a body: a head injury, breasts, trunks, extremities.
On character of the damaged fabrics: a trauma of a skin, mucous
Covers, sinews, muscles, bones, joints, bodies.
Simple trauma - if fabrics of one kind are damaged.
Difficult trauma - if various fabrics are damaged.
The homogeneous trauma - is caused by one factor.
Combined - it is caused by the several factor (for example
Mechanical trauma together with thermal).
Sochetannaja trauma - one-stage defeat of various systems (for example,
concussion of a brain and crises of bones, dislocations of joints).
Direct trauma - on a place of influence of the injuring agent.
Indirect trauma - far from a place of influence of the injuring agent.
Plural traumas (политравмы) are possible individual, and also.
Traumas the life both sharp, and chronic can.
Dangers and trauma complication
Numerous dangers of traumas can be divided into following groups:
The direct dangers arising at the moment of a trauma.
Bleeding
Collapse
Faint
Traumatic shock
Damage of vitals.
The nearest dangers which comes to light in different terms (from several
o'clock, about several weeks)
Local purulent infection
The general purulent infection
Traumatic a toxicosis
Late dangers and complications
Chronic osteomyelitis
Trophic ulcer
контрактура
Various anatomic and functional defects damage of bodies and fabrics.
Weight of damages and their consequences is defined by following conditions:
- The external factor which has led to damage, and the trauma mechanism.
- Anatomo-physiological features of fabrics and bodies, подвергшихся trauma
influence
- Presence or absence of pathological changes in the injured bodies
- Features of environment in which there was a trauma.
Concept about a traumatism
Traumatism - set of traumas in certain territory (the country, a city etc.)
or among a certain contingent of people (in agriculture, on manufacture, in
sports and.т.д.).
For traumatism definition study frequency of damages of the reason of
traumas, a condition and conditions at which they occur.
Studying of these moments, is necessary for traumatism preventive
maintenance
Distinguish 1) the industrial
2) the non-productive
The industrial:
The industrial
The agricultural
The non-productive:
The transport
The household
The children's
The sports
The railway
Suffered from traumas make 30-35 % from total number of surgical patients.
On level летальности the traumatism occupies 2-3 place after death
rate from diseases of cardiovascular system, along with oncological
diseases.
The traumatism takes the third place among all reasons of invalidity.
At men of a trauma meets twice more often, than at women, and at young men
till 40 years win first place in structure of the general disease.
To 8-10 % of patients with traumas need hospitalisation.
Death rate from various traumas on 100.000 population in Uzbekistan
makes nearby 230 persons, in the USA - nearby 80, and in the European
countries - 40-50.
In Uzbekistan about half of all cases makes a household traumatism,
transport - about 40 %, industrial - 5-6 %. Frequency of traumas
considerably above at the persons, suffering alcoholism.
THE REASONS OF HIGH FREQUENCY OF TRAUMAS:
- Industry developments
- Agriculture industrialisation
- An intensification of transport movement
For the account and traumatism preventive maintenance it should be
reflected following parametres:
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- Trauma type
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- Circumstance of a trauma at which it is received
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- A place and time incident
In work on traumatism preventive maintenance participate:
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- Production managers
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- Engineers under safety precautions
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- Workers of car inspection
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- Workers of housing-operational service
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- Employees of schools, kindergartens
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- Employees of system of public health services
For traumatism preventive maintenance it is made:
At employment:
- Corresponding training of workers
Acquaintance with rules under safety precautions
Cars are equipped with various protective adaptations
To workers protective clothes, points, mittens stand out
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For safety road movement:
It is established traffic lights at crossroads
сроятся pedestrian crossings and tunnels
It is spent regular checkups of vehicles
At schools movement is trained rules street
Features of inspection of patients with traumas
1. Appearance of a place of damage - not always corresponds to weight of
damage. For example, the small chipped wound in a breast or stomach wall can
be accompanied by heavy damages of an internal.
2. Not always the trauma, symptoms which are obvious, is menacing for human
life. So, at plural traumas more serious damages can, comes to light in
other sites of a body; at the patient with an extensive superficial wound of
a hand or a foot the closed crisis of a skull or liver rupture is possible.
3. At traumas the serious general phenomena (shock, a sharp anaemia, a
traumatic toxicosis) which it is necessary to estimate and render the
respective help correctly can be shown.
TRAUMATIC ILLNESS
Traumatic illness is an infringement of ability to live of the organism,
caused by a trauma and shown by a complex of frustration of a homeostasis
which at an inefficiency of the central regulation at treatment can lead to
occurrence of heavy complications (I.I.Derjabin) menacing to life.
Forms of traumatic illness:
1.
Traumatic illness with not complicated current
2. Traumatic illness with the complicated current and a favorable outcome
3. Traumatic illness with the complicated current and a failure
The periods of traumatic illness:
The first period - traumatic shock (the sharp period) - proceeds some hours
and is characterised by sharp cardiovascular insufficiency, decrease ОЦК,
infringement of microcirculation and development гипоксии. In this period
high level the maintenance of hormones аденогипофиза and barks of adrenal
glands in blood is marked. In this period render the urgent help to the
victim.
The Second period - the period of relative adaptation and occurrence of
early complications (early postshock) - proceeds to 7 сут, differs reduction
гипоксии and relative stabilisation of the general condition of the victim.
In this period carry out actions for the prevention of complications.
The third period - late complications (late posttraumatic) - is observed
only at patients with complications. In this period spend intensive
treatment of the developed complications.
The fourth period - the recover period. The absolute recovery of victims
comes quite often in some months after a trauma. In this period spend
rehabilitation of the patient.
The closed damages is called - damages as hypodermically-fatty клетчатки,
muscles, фасции, sinews, sheaves, vessels and nerves without infringement of
integrity of integuments and mucous membranes.
To the closed damages concerns: bruises, concussion, stretchings, rupture
and a syndrome long сдавление.
Bruise - traumatic damage of fabrics or bodies without infringement of their
integrity. Symptoms depend on the damaged part of a body, a kind and weight
of a subject, and also from speed of its influence.
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Clinic - a pain, a swelling, a hemorrhage, reddening or bruises of a
skin and infringement of function of these fabrics or bodies.
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Treatment - anaesthesia, 2-3 days a cold and pressing bandage. At
hematomas it is necessary to make a puncture, to evacuate contents and there
to enter antibiotics. Hematomas can resolve or be infected
Stretchings - At a stretching it is slightly closed it is damaged muscles
and sheaves. Damage of fabrics occurs owing to influence of two opposite
directed forces, also strong draught at the fixed position of a body. Clinic
and stretching treatment just as at bruises.
Concussion - the closed mechanical damage of soft fabrics, thus infringement
of their function, morphological change is not marked. Degree concussion
depend at most, time influence, elasticity and on a consistence of the
injuring agent.
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The Patologoanotomichesky picture - local hemorrhages, деструкция
органелл cages and стаз blood in small vessels.
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The concussion Clinic - depends from microscopic change in fabrics.
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Local symptoms: a pain, decrease in sensitivity and skin colour
change. Influence of the injuring agent lasts long (especially vibrating
devices) morphological change in fabrics happens is more expressed,
accordingly damaged functions of fabrics. Vibrating illness at this time
begins. Concussion of soft fabrics meets seldom. At strongly injuring agent
there is a concussion of a brain and thorax bodies.
Rupture - if fabrics outside do not keep anatomic unity, it is a question of
rupture. At influence forces are more stronger, than elasticity of fabrics
there are ruptures. Because of high elasticity of a skin ruptures of skin
happen seldom, and rupture hypodermically-fatty клетчатки, muscles, фасции,
sinews, sheaves, vessels and nerves meets often.
Clinic. On a rupture place there is a pain, a swelling and a
hemorrhage. Ruptures happen full and partial. Complete separations are
treated by operative intervention.
SHOCK
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CLASSIFICATION
1. Depending on the development reason:
- гиповолемический (травматичесий, burn, operational, геморрагический)
- анафилактический, кардиогенный, septic
2. On weight shock conditionally share on
- Compensated
- декомпенсированный
- Paralytic
3. On development time:
- Primary, early
- Secondary, late or toxic
4. On phases:
- эректильная
- торпидная
TRAUMATIC SHOCK
Traumatic shock arises owing to progressing reduction ОЦК with deterioration
of a capillary blood-groove. Sharp infringement of microcirculation quickly
leads to death owing to гипоксического infringement of function of vitals of
bodies (гиповолемия, a hypotension, гипоксия - three «Г», on expression
Fine).
The erektilnaja phase of shock develops in the trauma moment, it is
supported by a severe pain and mental experience. This phase happens shortterm, from several seconds to a half an hour. This phase is characterised by
mental excitation and reminds a phase of narcotic intoxication. N.I.Pirogov
is described figuratively it by a shock phase as follows: «if the strong cry
and groans are heard from wounded at which lines have changed, the person
has become long and convulsively bent, pale turned blue and swelled from
shout if at it pulse is strained and fast, breath is short and frequent,
what there was its damage, it is necessary to hasten with the help».
And торпидную a phase of shock of N.I.Pirogov describes as follows: «with
the torn off foot or a hand lies such окоченелый on dressing point
motionlessly: he does not shout and does not cry out, does not complain,
does not accept in what participation and does not demand; the body is cold,
the person is pale, as at a corpse; the sight is motionless and turned into
a distance, pulse as a thread, swept hardly up under a finger and with
frequent перемежками. Questions окоченелый either at all does not answer, or
only about itself hardly with audible whisper, breath too is hardly
perceptible. The wound and a skin almost are at all tolerant; about if the
big nerve hanging from a wound, something will be angry, sick of one easy
reduction of obverse muscles finds out a sign of feelings. Sometimes this
condition passes in some hours from the use of stimulants, sometimes it
proceeds to the death».
On weight of clinical displays differs following degrees of shock:
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- I degree - the general condition of the patient of average weight,
pulse of 80-100 ud/mines, макс. А/Д 90 mm рт the item
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- II degree - conditions of the patient heavy, increase of pulse to
100-140 ud/mines, reduction А/Д within 90-70 mm рт the item
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- III degree - conditions of the patient very heavy, pulse of 120-160
ud/mines, А/Д 70-50 mm рт the item
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- IV degree (preagony) of a condition extremely-heavy - pulse is
probed hardly on the main arteries, maximum А/Д 50 mm рт ст or are not
defined at all.
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Treatment of traumatic shock should be pathogenetic and complex.
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Principles shock treatment:
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Reduction of excitability ЦНС (drugs, антигистаминные means,
новокаиновые blockade a medical narcosis).
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Haemodynamics and completion ОЦК Normalization (полиглюкин,
реополиглюкин, макродекс, альбумин, желатинол, гелафузоль, physiological
solutions).
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Oxygen Inhalation, ИВЛ, hyperbaric oxygenation.