Komplikacije prijeloma rebara

master's thesis

• Title (english): Complications of rib fracture
• Author: Dominik Draženović
• Mentor: Vedran Cesarec (mentor)
• Committee member: Ivan Dobrić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Vedran Cesarec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Najčešća traumatska ozljeda toraksa je prijelom rebara. Prijelom rebara ukazuje na značajan prijenos energije na unesrećenog i postojanje okultnih ozljeda na koje je bitno posumnjati. S obzirom na to da koštani toraks obuhvaća i na neki način štiti korijen vrata, intratorakalne i intraabdominalne organe, ozljede koje nastaju uslijed prijeloma rebara mogu biti opsežne. Opsežnost ozljeda je pravilo što je i razlog da se trauma toraksa nalazi na drugom mjestu uzroka smrti uslijed traumatskog ozljeđivanja (traumatska ozljeda mozga nalazi se na prvom mjestu), a trauma općenito kao uzrok mortaliteta broj jedan od 1-44 godine života. Prilikom ozljeđivanja prva tri rebra pored intratorakalnih ozljeda unesrećeni može imati i ozljede struktura korijena vrata (npr. Laceracija neurovaskularnih struktura frakturnim ulomcima). Prijelomima četvrtog, petog i šestog rebra uglavnom su zahvaćena pluća (laceracija i kontuzija), a pri velikim prijenosima energije srce i velike krvne žile, diafragma i ezofagus. Prijelomi ispod šestog rebra mogu oštetiti i intraabdominalne organe (jetra, slezena, bubreg). Najčešće je zbrinjavanje pacijenta s prijelomom rebara konzervativno. Za uspješan oporavak bitna je adekvatna analgezija kako bi pacijent mogao adekvatno ventilirati pluća i čistiti dišne putove od sekreta. Ako pak to ne uspijeva sam, upotrebom bronhoskopije čisti se obilni sekret. Nastupom respiracijske insuficijencije razmatra se upotreba mehaničke ventilacije koja se pokušava gore navedenim metodama izbjeći. Najčešća komplikacija prijeloma rebara je upala pluća koja je odgovorna za veći dio smrtnih ishoda nakon pretrpljene traume toraksa.

Abstract (english)

Most common traumatic thoracic injury is rib fracture. Rib fracture requires major transfer of energy on patient and alerts threating physician to search for occult injuries. Considering that bony thorax envelops and protects structures of the root of the neck, intrathoracic and intraabdominal organs, injuries sustained during rib fractures can be extensive. Extenssiveness of injuries is the rule and it is the reason why thoracic trauma is on the second place as a cause of mortality among trauma patients (traumatic brain injury is a cause number one). In general, trauma is a number one cause of mortality among 1-44 age group. Besides intrathoracic injuries, patient sustaining injuries to the first three ribs can have injuries to the structures of the root of the neck (eg. Laceration of neurovascular structures with bony fragment). Fractures of fourth, fifth and sixth rib injures lungs (laceration and contusion), and in cases of immense transfer of energy heart and great vessels, diaphragm and oesophagus. Rib fractures lower than sixt rib can injure intraabdominal organs as well (liver, spleen, kidney). Management of patient with rib fracture is usually conservative. For positive outcome it is very important to provide adequate analgesia in order to properly ventilate lungs and remove secretions from the airways. If that measures are not enough, through bronchoscopy can the airways be cleaned. Mechanical ventilation is considered in patients who develop respiratory insufficiency, which should be avoided by above measures. Most frequent complication of rib fracture is pneumonia which is responsible for great part of deads after thoracic trauma.

• Keywords: prijelom rebra; komplikacije prijeloma rebara; ventilacija pluća; respiracijska insuficijencija
• Keywords (english): rib fracture; complications of rib fractures; lung ventilation; respiratory insufficiency
• Language: croatian
• URN:NBN: urn:nbn:hr:105:349969
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-11-14 12:09:31