Gunshot wounds to the chest and abdomen

Gunshot wounds, not even in wartime, are often treated as surgery "military-urban" order. This concept was introduced in 1998 by B. V. Pegrovsky. After all, without understanding military medicine and surgery to treat gunshot wounds to the stomach and chest is very difficult.

That's why near the military areas it is supposed to place more medical institutions, in order to provide emergency assistance to all those wounded in case of mass destruction.

In the case of a gunshot wound it is very important to quickly provide medical assistance to the victim. It is the temporary factor that determines the number of deaths, which can be judged from the statistics. During the First World War, 80% of the victims died from gunshot wounds to these parts of the body, and during the Great Patriotic War, 50% of the wounded died. Currently, only 25-30% of the victims are fatal.

The main causes of death in a gunshot wound: 88.9% shock, too high blood loss 22% and peritonitis 76%.

Treatment of gunshot wounds of military and peaceful times is still different. In peacetime, the victims receive medical assistance more quickly, but today, gunshot injuries are very diverse, and there is a significant loss of blood in the wound.

Often the patient gets with such a rare wound to a general surgeon. Naturally, such a surgeon does not know exactly how to perform an operation, or does not take into account possible reactions, so the number of deaths after injury is increased in the chest and abdomen.

According to statistical data, the mortality rate of outcomes in cases of chest injuries is 16.2%, thoracoabdominal - 80%, abdominal cavity - 36%.And this makes the topic relevant even in peacetime and with modern medicine.

Information on the treatment of these wounds in our time is very contradictory, as is the algorithm of the surgeon's actions when the injured person enters the hospital.

Gunshot wounds of the abdomen and chest in peacetime.

Despite the inconsistency of the algorithm for treating gunshot wounds today, there are some peculiarities of hospitalization of a patient with gunshot wounds. Modern treatment of gunshot wounds has such differences and possibilities:

1. Gunshot wounds of the chest and abdomen in the non-military time have their own specific features. The hospital receives patients with the defeat of vital organs due to lack of protective equipment. Already in the ambulance, a wounded person begins to receive anti-shock and resuscitation assistance, thereby reducing the number of deaths. After all, shock is the first cause of death of a wounded patient. In 81% of cases the ambulance arrives to the victim up to 1 hour after the injury. In the postoperative period, the victim is constantly monitored in the intensive care unit.
2. Diagnosis of the patient's condition with gunshot wounds of the chest and abdomen revealed a traumatic shock in 88.3%, bleeding 74.8%, bleeding at 38.8%, breathing problems 43.7% and acute cardiovascular insufficiency 15.5%Wounded.
3. Thanks to the introduction into the modern practice of surgery, the algorithm for working with gunshot wounds has made possible minimal intervention. Thus, drainage of the pleural cavity is made - 27.1%, resection of the organ - 11.7%, stitching of wounds of the parenchymal and hollow organs - 44.7%, and removal of the organ - 16.5%.This practice can be applied not only in urban, but also in district offices.
4. The main thrust of working with gunshot wounds to the abdomen is aimed at reducing the number of deaths. Programmed sanation with the help of magnetic laparostomy, as well as complex treatment with the use of antioxidant microhydrin, reduced mortality from 16.7% to 7.1%.
5. Thanks to the developed peacetime algorithms, surgeons manage to reduce the lethality of the abdomen from 35.5% to 25%, and with chest injuries from 33.3% to 20%.

Practical recommendations for gunshot wounds.

The most important thing in getting a victim with a gunshot wound to his chest is following the standard algorithm. First, a thorough clinical examination, ultrasound of the chest and radiography should be done. Then a turn of a pleural puncture with the subsequent laboratory researches, an electrocardiogram, and also calculation of a shock index of Algovera, for definition of a status of the victim.

In the treatment it is necessary to follow the following algorithm, which determines the prevailing syndromes, it is necessary to drain the pleural cavity in the II and VII intercostal space along the corresponding lines. In order for the patient not to die from pain symptoms and shock, he should be given an anesthetic. After assessing blood loss, you need to restore the necessary amount of blood in the human body. It is necessary to perform a primary surgical treatment of the wound and prepare everything for carrying out thoracotomy.

Any gunshot wounds of the abdomen, especially penetrating wounds, must first be diagnosed, for this it is necessary to conduct clinical and laboratory studies using special methods of modern practice in medicine( primary wound treatment, excretory urography, catheters, surgical cystography, ultrasound, chest X-ray and abdominalCavity).

The therapeutic algorithm of action for injuring the abdomen is considered to be the minimum amount of work for surgical intervention: suturing the wounds of the hollow organs of the abdominal cavity;Blood reinfusion( if there are no contraindications), with complete organ ruptures, its removal and resection with severe injuries and multiple injuries.