Lung laceration repair

Tension pneumothorax can be caused by a closed or penetrating chest injury. Because the damaged tissue of the chest wall, lungs, trachea and other forms a one-way valve, the air pushes the wound flap into the chest cavity during inhalation, and the flap closes when exhaling, so that the air can only continuously enter the chest cavity and cannot be discharged, so that the pleural cavity The pressure is constantly increasing. Thus, the injured side lung tissue is compressed, and the mediastinum is pushed to the healthy side, and the healthy side lung is compressed, thereby reducing the lung ventilation and effective ventilation area, resulting in hypoxia. In addition, because the blood flow is still perfused with the lung tissue, no oxygenation can occur, resulting in a shunt, which is more hypoxemia. Displacement of the mediastinum, distortion of the large blood vessels of the heart, and increased pressure in the pleural cavity can result in obstructed blood flow to the venous return, reduced cardiac output, and circulatory failure. The wounded showed irritability, extreme breathing difficulties, cyanosis, rapid and weak pulse, and decreased blood pressure. If there is no hypovolemia, venous engorgement may occur due to venous return obstruction. Often accompanied by mediastinal and subcutaneous emphysema, the injured side of the chest is full, the thoracic activity is significantly reduced, the percussion is drum sound, the breath sound disappears, the trachea is obviously biased to the healthy side. Chest puncture pressure measurement, the chest pressure is positive pressure, and high pressure gas is discharged. The condition of tension pneumothorax develops rapidly. If the treatment is not timely, it can quickly die due to respiratory and circulatory failure. Do not delay the rescue time due to X-ray examination during the rescue. In an emergency, the chest can be decompressed with a thick needle in the second or third intercostal space, and then the thick needle is connected to the water-sealed bottle with a rubber tube, and the gas in the chest can be continuously discharged. When transporting the wounded, a rubber finger sleeve can be placed on the outer mouth of the needle, and a small opening is made at the top to make a flap discharge needle. When exhaling, the gas is discharged, and the rubber finger sleeve is closed when inhaling, blocking the outside air from entering the pleural cavity. If a special pleural venting needle is available, the effect is better. If the tension pneumothorax is still uncontrollable, a closed tube with a diameter of 0.5 to 1.0 cm should be inserted into the second or third intercostal space of the clavicle midline under local anesthesia for closed drainage. It has also been suggested that a thick tube drainage should be placed at the fourth or fifth intercostal space of the midline of the sacral line to simultaneously accommodate drainage with the hemothorax. Drainage should be placed between the 4th or 5th intercostals of the midline of the Yuzhong line. It is advisable to use the incision method because the diaphragm can rise to a relatively high position after the injury, and if the diaphragm is broken, the abdominal organs can be inserted into the chest cavity and the fingers are probed. Insert the drainage tube to avoid damage to the diaphragm and the internal organs. If the dyspnea after the closed thoracic drainage still fails to improve, if there is a suspected severe pulmonary laceration or bronchial rupture, the chest should be explored in time. Treating the disease: atelectasis Indication If the thoracic closed drainage is found to have severe air leaks, and there is no significant improvement in dyspnea after drainage, the lungs can not be re-expanded, emergency diagnosis and thoracic exploration. If a lung laceration is found, it can be repaired and the lung tissue preserved as much as possible. If the laceration is extremely severe and cannot be repaired or combined with severe pulmonary contusion, the lung segment, lung lobe or pneumonectomy may be feasible. Surgical procedure 1. After entering the chest, if there is more blood in the chest cavity and there is no pollution, it is feasible to return the blood of the chest to the body. Suck the blood in the chest and find the rupture of the lungs. If the gap is shallow, suture the bleeding and leaking parts with silk thread, and suture the suture intermittently or suture. If the gap is not large but deep, the gap should be enlarged and the bleeding and leaking parts should be carefully sewed. Large and deep cleft, with thicker bronchial or vascular damage, should carefully find the leaking bronchial and bleeding blood vessels to be sutured or sutured, in order to avoid the occurrence of air embolism, the split can be opened and not sutured. 2. Rinse the chest cavity and sputum the anesthesiologist to check the lungs and check for any leaks and missing lung lacerations. 3. Patients with closed thoracic drainage were placed in the lower position and placed in closed drainage. The drainer has been placed and should be adjusted if the location is inappropriate.