A few rib fractures: the chest wall can be fixed with adhesive tape, which can limit the respiratory movement of the chest wall and reduce the activity of the fracture end, thus achieving the purpose of relieving pain. The method is that each band is 7 cm wide and the length is about 10 cm longer than the patient's chest. The patient sits with his arms extended or raised. At the end of expiration, that is, when the chest circumference is the smallest, the tape is first attached to the front and back sides 5 cm outside the midline, and then 5 cm across the front midline from back to front. The first one is attached to the fracture, and then two or three tiles are added up and down (overlapping 1cm). The fixed time is about 3 to 4 weeks. This method is simple, easy to obtain materials, and the sticking method is correct, which can reduce the friction and pain at the bone end, but the disadvantage is that the fixation is not firm, which hinders breathing, is not conducive to coughing and expectoration, and improper application can lead to fracture displacement. Therefore, this method is not suitable for multiple rib fractures, the elderly and obese patients.
Multiple ribs and one fracture: Vagus nerve, phrenic nerve, sympathetic nerve of blood vessel wall and intercostal nerve are the main ways to transmit pain in chest trauma. Therefore, for multiple rib fractures complicated with chest injury, cervical and sympathetic nerve block can be used to prevent the bad stimulation of pain to the body, thus improving the condition and benefiting the treatment of complications. If multiple rib fractures are combined with severe chest operators, it often leads to poor gas exchange and secretion can not be removed, resulting in dyspnea and cyanosis. Tracheotomy can be used for sputum aspiration and oxygen supply to improve gas exchange and respiratory efficiency.
Multiple rib folds: In addition to systemic pain, abnormal breathing will also lead to decreased respiratory efficiency, systemic hypoxia and blocked venous return, which will seriously affect circulation. If the above methods can't solve the abnormal breathing, rib traction or steel wire internal fixation can be used to eliminate chest wall floating and correct thoracic invagination. Rib traction is to select 1 ~ 2 struggling ribs in the center of floating chest wall, clamp the depressed ribs with tweezers under local anesthesia, and eliminate the floating of chest wall by sliding traction, with a weight of 0.5 kg ~ 1 kg and a time of 1 ~ 2 weeks.
Patients complicated with pneumothorax can adopt exhaust method, that is, the needle is inserted at the midline of the second intercostal sternoclavicular to release the gas.
For patients with non-progressive hemothorax, hematocele can be sucked out between the 6 th and 7 th ribs of the posterior axillary line. If there is a lot of hematocele, it can be aspirated several times, once a day, and the amount does not exceed 1000 ml. Antibiotics can be injected after each aspiration to prevent infection. For progressive hemothorax, after anti-shock, intravenous or intra-arterial blood transfusion, the chest should be opened properly to stop bleeding, and the drainage tube should be inserted for bottle drainage after operation, that is, closed drainage.
[practice]
After fixation, the light person can move freely on the ground, and the heavy person needs to rest in bed or semi-recumbent position, and carry out abdominal breathing exercise. He should move freely on the ground as soon as his symptoms are relieved.
[drug therapy]
At the initial stage, we should promote blood circulation to remove blood stasis, regulate qi and relieve pain. Those who are mainly injured by qi should regulate qi and relieve pain, supplemented by promoting blood circulation and removing blood stasis. You can choose Liqizhitong Decoction, Jinlingzi Powder and Chaihu Shugan Powder, and Fructus Trichosanthis, Semen Armeniacae Amarum and Fructus Aurantii can be added for patients with cough due to adverse qi. For patients with blood injury, it is advisable to promote blood circulation and remove blood stasis, supplemented by regulating qi and relieving pain. Fuyuan Huoxue Decoction, He Ying Zhitong Decoction and Xuefu Zhuyu Decoction can be added. Yunnan Baiyao or Notoginseng Radix can be added for patients with severe pain, and Bletilla striata, Herba et Gemma Agrimoniae and carbonized blood can be added for patients with hemoptysis. For patients with deficiency of both qi and blood, it is advisable to promote blood circulation and remove blood stasis, and pay equal attention to regulating qi and relieving pain, which can be modified by Shunqi Huoxue Decoction. In the middle stage, it is advisable to replenish qi and nourish blood, set bones and continue tendons, and you can choose Jiegu Zijindan and Jiegu Dan. In the later stage, the chest and ribs are dull pain, so it is advisable to remove the stasis and dampness, promote the circulation of qi and relieve pain, and you can choose Bazhen Decoction and Chaihu Shugan Powder.