Closed uncomplicated fracture 4-8 ribs on the left with displacement.
History of the disease in traumatology
Closed uncomplicated fracture 4-8 ridges on the left with displacement. The fracture of transverse processes 2,3,4 of the lumbar vertebra to the left.
The patient complains of general weakness, moderate pain in the chest area on the left and in the left osteoporosis region. Also, the patient presents complaints of moderate pain while walking, sometimes appearing headache of low intensity.
History of the disease
According to the patient late in the evening, 24.11.2003 was beaten up by unknowns on the street. After the first blow, he fell to the ground, after which the unknown continued to beat him with his feet. Consciousness did not lose. After receiving an injury, he felt a pain in the left half of the chest, in the poplar area, a severe headache (the result of kicking the head). From the patient’s words, he was sober at the time of injury. Appeared to the doctor at the place of residence only 27.11.2003, was called “SP”, which delivered the patient to the Petrozavodsk traumatology point. In injuries. A review was made of the R-gram of the chest and the patient was sent to the BSMP with the diagnosis: Closed fracture of 6,7,8 ribs to the left. Fracture of transverse processes 2,3,4 of the lumbar vertebra to the left. Temperature at entry 36.7 ° C, BP 190/100 mm Hg. Art. During the admission the patient complained of headaches, pain in the chest area on the left and pain in the left lumbar region. Examined by the on-call traumatologist, for further treatment he was admitted to the traumatology department. One time on 27.11.03 is given a tablet of clonidine. Analgesics, physiotherapy, antibiotic therapy, examination of the patient and neurosurgeon are appointed. A review of the R-gram of the chest organs is performed.
History of life
The patient was born in Sortavala district on April 11, 1949. The only child in the family. Ros and developed according to age. At the age of 5 he moved to Zaozerie with his parents. There he graduated 9 classes. He studied satisfactorily. At the end of school I entered the Building Technical School of Petrozavodsk. He graduated from it and then worked in a profession. Married in 1978, a daughter was born, after 2 years she broke up. Has not worked during the last 3 years; from the patient’s words he resigned himself. The diet does not meet the patient.
Harmful habits: Smokes from 19 years by half a pillow per day (cigarettes without a filter). Alcohol consumes often, mostly vodka. On the day of injury, alcohol was not consumed.
In childhood, hepatitis B, tuberculosis, and venereal diseases were denied.
Allergic history of calm, intolerance of food products and medicines the patient does not mark.
Data of the objective survey
The patient in the consciousness, the expression of the person is meaningful, the speech is clear, the voice is loud. The general condition of the patient: satisfactory. Body type: normostenic, moderate nutrition.
Skin and mucous membranes of pale pink color, unchanged.
Subcutaneous fatty tissue expressed moderately, spread uniformly.
Examination of the pharynx: mucous pink, normal humidity, no hyperemia. The tonsils are not enlarged, clean. Neck is the right shape. Peripheral lymph nodes are not enlarged. There is no swelling and pulsation of jugular veins. Passion, no edema.
Swelling of the cervical veins, extension of the subcutaneous veins of the torso and the limbs, and also the visible ripple of the sleep and peripheral arteries are absent. There is no cyanosis, shortness of breath, peripheral edema.
When palpation of the arterial arteries, the pulse is the same on both hands, rhythmic, normal tension, satisfactory filling, in size large, in form – normal, heart rate of 75 beats / min, || | 157
At palpation: Apical impulse is defined on the left by 1 cm from the mid-clavicular line in the region 5 of the intercostal space. Upper thrust of low, moderate force, 2 cm wide. The phenomenon of “feline murring” is negative.
When auscultation: tone of the heart is clear, rhythmic. Pathological noises are not audible.
- Boundaries of the relative dullness of the heart:
Right – at the level of 4 intercostal space passes along the right side
the edge of the sternum
Left – at the level of 5 intercostal space by 1.5 cm from the
left mid-clavicular line
Upper – on the left oblique line on 3 ribs
- The limits of absolute dullness of the heart:
the edge of the sternum
Left – at the level 5 of the intercostal space on the 2.0 cm of the inside of the
Upper – on the left perrhotium line on 4 ribs
Configuration of the heart is not Menen.
Osmotr and palpation, not deformyrovan Nos. Breathing through the nose is free. The pains are independent or at the pressure and excretory at the tip of the nose, in the places of the frontal sinus and gaymorous cavities is not observed. The larynx is normal, the feeling is painless. Pain when talking, swallowing no. The voice is loud, clean.
The shape of the thorax is cylindrical. The right and left half of the chest are symmetrical. The above and the subclavian fossa are marked weakly, expressed equally to the right and to the left. The movement of both halves of the chest is synchronous, the left half of the chest is slightly lagging behind in the act of breathing. Auxiliary respiratory muscles do not participate in breathing. Circumference of the chest at the level of the lower angles of the shoulder blades and IV edges in the front: at rest breathing – 89 cm, with maximum inspiration – 92 cm, with maximum exhalation – 86 cm. Maximum excursion of the chest – 6 cm. The type of respiration – predominantly abdominal. Respiratory rate – 18 per minute at rest. The rhythm of breathing at rest is correct.
With palpation of the chest, pain on the left side, tension of the muscular carcass. Voice tremor is not changed, it is felt in symmetrical parts of the chest with the same force. The thoracic cell is elastic.
Percussion of the lungs.
- With a comparative percussion over the whole surface of the lungs, clear lung sounds are determined.
- At topographic percussion:
Lower boundary of the lung
|Landmarks||Right (edge)||Left (edge)|
|– < / p>
Width of the fields of Krenig:
With auscultation in the lungs vesicular breathing. Side-effects of breathing noises are not heard.
Lips of physiological color, slightly damp, rashes and cracks not found, Mucous membranes of the mouth of uniform pink color, language Normal size and shape, wet, pink, clean, soft and firm, pink sky, no spots and plaids, tonsils are not enlarged. Unpleasant smell from the mouth is not marked, swallowing is not disturbed. The abdomen is round, both sides are symmetrical, the navel is moderately drawn, the abdominal skin has a normal color, no strengthening of the venous pattern on the anterior abdominal wall. The abdomen is painless. Free fluid in the abdominal cavity is not defined. Symptoms of flatulence, visible peristalsis have not been detected. Symptom Shchetkin-Blumberg negative.
Stomach. With percussion, the lower bound is determined 3 cm above the navel. Large curvature is located 3 cm above the navel, the stomach wall is even, elastic, movable, painless.
Intestine. With superficial light palpation pain is absent. All sections of the intestine are located correctly, of normal diameter, elastic, the wall is smooth, smooth, movable, painless, there is no rash.
Liver. Limits of the liver by Kurlov 10, 9 and 8 cm. With superficial palpation of the liver, soreness was not detected. At deep – on a deep breath, the edge of the liver comes out from under the edges of the edge arc by 0.5 cm along the linea clavicularis dextra. The edge of the liver is elastic, smooth, rounded, painless. Symptom Curvoise is negative. The symptoms of Myiss, Ortner are negative. The spleen is not palpated.
The character is calm, stable, friendly to the medical staff. Focused on time, place, situation. Euphoria, delirium, hallucinations are not noted. The dream is not broken. Pathological reflexes have not been revealed. Occasionally there is a headache. Cramps and involuntary movements are not observed, there are no trophic disorders and pain in the course of the nervous trunks, the smell and taste are not disturbed. Movement of eyeballs in full volume, vision is normal, pupil form is correct, D = S; on the part of the craniocerebral nerve pathology is not detected, the mimic musculature is symmetrical, there is no grinning teeth, the tongue is in the middle. There is no pathological changes on the part of the hearing.
The genitourinary system
The lumbar region during the examination has not been changed. There is a moderate palpatory tenderness of the poplar area to the left. The kidneys in the positions of lying on the back and standing do not palpate. The symptom of Pasternak is negative. Color of urine is yellow. Diuresis is not disturbed. When palpation, the bladder does not protrude beyond the upper edge of the pubis.
The musculoskeletal system
The muscular system is satisfactorily developed, the muscles are painless, the tone and their strength are sufficient.
Physical form is correct. The posture is correct. Half the body is symmetrical. The upper arms are located on the same level. There is no deformity of the chest. The blades are not deformed, the blades are angled downwards.
The joints are not externally altered. The configuration of the spine is correct. Movement in joints in full volume. Spine: physiological curves are sufficiently expressed, pathological bends are absent. Movements in the joints of the spine are limited at the level of injury (fracture of transverse processes 2,3,4 of the lumbar vertebrae) as a result of the pain syndrome. The painfulness of the chest on the left side of the posne-axillary line is noted at the level of injury (fracture 4,5,6,7,8 ribs). Pain increases with deep breathing, coughing, straining.
There is no obvious deformation of the fracture sites. The patient’s position
is more active, although he himself notes that it is difficult to perform certain types of movement due to pain.
- Data of anamnesis: According to the patient late in the evening 24.11 .2003 was beaten up by unknowns on the street. After the first blow fell to the ground, after which the unknown continued to beat him with his feet.
- Complaints of the patient: Complaints to the general weakness, moderate pain in the chest area on the left and in the left osteoporosis area . Also, the patient presents complaints of moderate pain when walking, sometimes appearing headache of low intensity.
- Data of objective research: local tenderness 4,5,6,7,8 ribs along the posneoxylary line , pains increase with deep breathing, coughing, straining. Swollen chest area on the left. At the level of 4,5,6 ribs, the hematoma is visually detected along the posne-axillary line. Local pain in the left parvertebral line at the level of L 2-4. There is a slight lag in the affected half of the chest in the breath,
can be put Preliminary diagnosis: Closed fracture 4-8 rovers on the left. The fracture of the transverse processes 2,3,4 of the lumbar vertebra to the left.
Overview R – Gram of the organs of the chest cavity from 27.11.2003
Conclusion: On the review R-gram of the organs of the chest cavity – to the left of the fracture 4,5,6,7,8 ribs offset There is no hemopneumothorax. Pulmonary parenchyma, vascular pattern, heart is normal.
ECG of November 28, 2003
- Heart rate 68 beats per minute
- Р 0.12
- PQ 0.15
- QRS 0.10
- RR 1.24
Examination of the neurosurgeon from 27.11.2003
The condition is satisfactory. Complaints for periodic headaches. The loss of consciousness categorically denies. In the clear consciousness, is adequate, oriented. Pupils D = S, no nystagmus. The face is symmetrical, the language is centered. Paresis, no meningeal signs.
Based on anamnesis data, patient complaints, data of objective research ( Listed above), as well as data from the review radiography of the chest organs, can be delivered.
Closed uncomplicated fracture 4-8 ridges on the left with displacement. The fracture of the transverse processes 2,3,4 of the lumbar vertebra to the left.
For this type of injury it is recommended that conservative treatment :
- Bed rest 1-4 days
- Diet № 10
- Sol. Analgini 50% -2.0 2 times a day (v / m)
- Penicillin 1 million 6 times a day (v / m)
- Breathing gymnastics with 1 day
- Therapeutic physical training
The curriculum diary
29.11.2003 The situation is relatively satisfactory. Complaints for general weakness, pain in the chest area on the left and in the left osteoporosis area. Also, the patient complains of sometimes appearing headache of low intensity. There is no lung rhinitis. The tones of the heart are clear, rhythmic. Blood pressure 130/90 mm hg Art. Pulse 78 beats per minute. The stomach is soft, painless, physical departures are normal.
01.12.2003 The situation is relatively satisfactory. Complaints of pain in the chest area on the left and in the left osteoporosis area. However, the patient notes a decrease in pain. Also, the patient complains of sometimes appearing headache of low intensity. There is no lung rhinitis. The tones of the heart are clear, rhythmic. Blood pressure 140/90 mm Hg. Art. Pulse 76 beats per minute. The stomach is mild and painless, physical departures are normal.
According to the patient, late on the evening of November 24, 2003, he was beaten up by unknown people on the street. After the first blow, he fell to the ground, after which the unknown continued to beat him with his feet. Consciousness did not lose. After receiving an injury, he felt a pain in the left half of the chest, in the poplar area, a severe headache (the result of kicking the head). From the patient’s words, he was sober at the time of injury. Appeared to the doctor at the place of residence only 27.11.2003, was called “SP”, which delivered the patient to the Petrozavodsk traumatology point. In injuries. A review was made of the R-gram of the chest and the patient was sent to the BSMP with the diagnosis: Closed fracture of 6,7,8 ribs to the left. Fracture of transverse processes 2,3,4 of the lumbar vertebra to the left. Temperature at entry 36.7 ° C, BP 190/100 mm Hg. Art. Objectively upon arrival: local pain 6,7,8 ribs on the left on the posne-axillary line, subcutaneous emphysema is absent. There is an increase in pain with deep breathing, coughing, straining. Local morbidity on the left on the parvertebral line at the level of L 2-4. Examined by the on-call traumatologist, for further treatment he was admitted to the traumatology department. In the traumatology department a review R-gram of the organs of the thoracic cavity is made. Diagnosed: Closed uncomplicated fracture 4-8 ridges on the left with displacement. On the basis of patient complaints, data of anamnesis, objective research and radiography, a clinical diagnosis was made: Closed uncomplicated fracture of 4-8 ridges on the left with displacement. Fracture of transverse processes 2,3,4 of the lumbar vertebra to the left. During the stay in the hospital symptomatic treatment (painkillers) was performed. Preventive maintenance of pneumonia (respiratory gymnastics) was carried out. Antibacterial therapy was carried out.
The patient continues treatment in the traumatology department of the BSMP.