Expanded knowledge about the pathophysiologic effects of severe in juries, advancements in the intensive care of victims of multiple injuries, and the treatment made possible by modem cardiovascular surgery make it appear sensible to combine the assessment and therapy of thoracic injuries into a synthesis of various branches of medicine. This monograph, therefore, is intended not only for the specialist in thoracic or cardiac surgery but also primarily for the person who is the first to be confronted by thoracic injuries, namely, the general surgeon or the traumatologist. It reflects my own personal experience as chief surgeon of an emer gency surgery ward of a university hospital and as head of an inten sive care unit for the severely wounded, which treats well over 100 patients with severe thoracic injuries annually, and is based on an analysis of these cases. My experience as a military surgeon in Vietnam was also taken into consideration. Many wounds in the area of the thorax can be successfully treated with simple, conservative procedures, though by "conservative" I do not mean to imply "inactive." An aggressive conservatism is need ed, which must pay attention to small details. In given cases, how ever, it requires the quick decision-making capability of the com petent surgeon. For this reason, considerable space is devoted to questions of evaluation and practical procedures.
Sprache
Verlagsort
Verlagsgruppe
Zielgruppe
Gewicht
ISBN-13
978-3-540-10409-4 (9783540104094)
DOI
10.1007/978-3-642-67857-8
Schweitzer Klassifikation
I General Considerations for the Assessment and Treatment of Thoracic Injuries.- 1 Initial Considerations in the Management of Severe Thoracic Injury.- I. The Ten Vital Questions in the Initial Evaluation of Severe Thoracic Injuries.- II. Evaluation after Initial Management.- 2 The Patient with Additional Injuries in Other Parts of the Body.- I. Craniocerebral Injuries.- II. Intra-abdominal Injuries.- III. Injuries of the Extremities.- IV. Maxillofacial Injuries.- V. Injuries to the Vertebral Column and Spinal Cord.- 3 Interpretation of the Chest Roentgenogram.- I. Basic Considerations.- II. Opacities.- III. Accumulation of Air.- IV. The "Widened Mediastinum".- 4 Respiratory Insufficiency.- I. Basic Considerations.- II. Assessment of Respiration in Patients with Thoracic Injuries.- III. Respiratory Insufficiency Caused by the Thoracic Injury Itself.- IV. Aspiration.- V. Adult Respiratory Distress Syndrome (ARDS).- VI. Fat Embolism.- VII. Other Forms of Respiratory Insufficiency Among the Injured.- VIII. Lung Damage Caused by Therapeutic Measures.- IX. Conclusions and Consequences for Prophylaxis and Therapy.- 5 Indications for Operation in Blunt Thoracic Trauma.- I. Indications for Immediate or Early Operation.- II. Indications for Subsequent Operations.- III. Contraindications to Operative Intervention.- 6 Operative Approaches.- I. Anterolateral Thoracotomy.- II. Posterolateral Thoracotomy.- III. Median Sternotomy.- IV. Approach to the Great Vessels of the Superior Thoracic Aperture.- V. Thoracoabdominal Approach.- 7 Special Considerations in Penetrating Chest Injuries.- I. Causes of Injury and Intrathoracic Injuries.- II. Evaluation and Therapeutic Procedure.- III. Prognosis.- 8 Aspects of Intensive Care of Patients with Thoracic Injuries.- I. Basic Considerations.- II. Monitoring and Evaluating the Patient with Thoracic Injuries in Intensive Care.- III. Mechanical Ventilation.- IV. Principles for the Infusion of Fluids.- V. Subsequent Pulmonary Complications.- 9 Physiotherapy of Patients with Thoracic Injuries.- I. Basic Considerations.- II. General Measures.- III. Forced Expiration.- IV. CO2-Induced Increase in Ventilation.- V. Intermittent Positive Pressure Breathing (IPPB).- VI. Maximal Voluntary Inspiration.- II Diagnosis, Clinical Significance, and Treatment of Specific Injuries.- 10 Rib and Sternum Fractures.- I. General Considerations.- II. Specific Types of Fractures.- III. Diagnosis.- IV. General Considerations for Therapy in Rib and Sternal Fractures.- V. Pain Control.- VI. Therapy of Flail Chest.- 11 Pneumothorax and Hemothorax.- I. Pneumothorax.- II. Tension Pneumothorax.- III. Open Pneumothorax.- IV. Hemothorax.- V. Clotted Hemothorax, Fibrothorax.- VI. Thoracentesis.- VII. Intercostal Tube Drainage.- 12 Traumatic Emphysema.- I. Subcutaneous Emphysema.- II. Mediastinal Emphysema.- 13 Lung Injuries from Blunt Trauma.- I. General Considerations.- II. Lung Laceration, Lung Rupture.- III. Intrapulmonary Hematoma.- IV. Traumatic Lung Pseudocysts (Pneumatoceles) 160 V. Lung Contusion.- VI. Blast Injuries.- 14 Tracheal and Bronchial Injuries.- I. Injuries to Trachea and Bronchi Caused by Blunt Trauma.- II. Old Bronchial Ruptures.- III. Penetrating Injuries to Trachea and Bronchi.- 15 Injuries to the Esophagus.- I. Rupture of the Esophagus, Penetrating and Iatrogenic Esophageal Injuries.- II. Traumatic Esophagotracheal Fistula.- 16 Injuries to the Heart by Blunt Trauma.- I. Basic Considerations.- II. Pericardial Injuries, Luxation of the Heart.- III. Hemopericardium, Cardiac Tamponade.- IV. Posttraumatic Pericarditis.- V. Cardiac Contusion.- VI. Heart Wall Ruptures.- VII. Traumatic Septal Defects.- VIII. Heart Valve Injuries.- IX. Injuries of the Coronary Arteries.- X. Traumatic Cardiac Aneurysm.- 17 Penetrating Wounds of the Heart.- I. Penetrating Cardiac Injuries.- II. Late Sequelae of Penetrating Cardiac Injuries.- III. Foreign Bodies in the Heart.- 18 Injuries of the Great Intrathoracic Vessels.- I. Rupture of the Aorta.- II. Penetrating Injuries of the Aorta.- III. Closed Injuries of the Supra-aortic Arteries.- IV. Injuries of the Great Veins and Pulmonary Vessels.- V. Penetrating Injuries of the Vessels of the Superior Thoracic Aperture.- VI. Posttraumatic Late Sequelae in the Great Vessels.- 19 Injuries of the Diaphragm.- I. Diaphragmatic Ruptures.- II. Penetrating Diaphragmatic Injuries.- 20 Other Injury Patterns and Consequences of Injury in Thoracic Trauma.- I. Traumatic Asphyxia.- II. Injuries of the Thoracic Duct, Chylothorax.- III. Cholothorax.- IV. Traumatically Induced Hernias of the Chest Wall.- V. Arterial Air Embolism.
