What is the test of Ruwilua-Gregoire?

In the world there is a large number of diseases, which many people do not even suspect. But there are cases when you just need to know about the symptoms of acute conditions of a person, in order to be able to immediately give the patient first aid. But not always the disease or serious pathology can be determined visually, in this case, modern diagnostic methods will come to the aid , for example, such as the Ruwila-Gregoire test. But what thanks to this trial can be determined and what kind of analysis is this at all?

Ruvlua-Gregoire: what is it?

This test is one of the diagnostic methods that allows you to quickly determine whether there is intrapleural bleeding or not with hemothorax. The positive test of Ruvila-Gregoire says that the bleeding inside the pleura continues, and the negative testifies to its stopping, or it is, but not so active.

But what is hemothorax, how to treat it, what are the consequences in case of inaction in such a patient's condition?

Hemotorax: what is it?

Hemotorax is a bleeding that occurs inside the pleura and leads to the accumulation of large amounts of blood in it, which is eventually accompanied by squeezing the lung. The test of Ruvelua-Gregoire allows in the shortest possible time to determine the presence of bleeding and its intensity. In addition to diagnosis, you can recognize blood loss for such symptoms:

• chest pain;
• low pressure;
• dizziness;
• Pale skin and others.

If the patient has such manifestations, then it must be urgently delivered to the hospital in order to diagnose and take all measures to stop bleeding. But what can provoke hemothorax?

Causes of pathology

Diagnosis of hemothorax may be necessary for those patients who have received a chest injury, are happy with pathologies or iatrogenic causes of bleeding.

Under trauma, doctors imply damage to the chest of a different nature. Hemotorax can develop as a result of an accident, a gunshot wound, a broken rib, a fall from a great height, and other causes.

Such injuries can damage not only the lungs, but also other organs:

• Heart;
• Liver;
• Spleen;
• Diaphragm;
• Intercostal vessels;
• Thoracic artery;
• Lungs.

Hemotorax can cause and illness of the patient, such as:

• Aortic aneurysm;
• tuberculosis;
• Malignant formation in the lungs or pleura;
• Abscess of the lung;
• Hemorrhagic diathesis;
• Coagulopathy and others.

Iatrogenic factors leading to hemothorax (to determine its presence will help test Ruvula-Gregoire), complications arise after surgery on the lung or pleura, draining the pleura, installing a catheter into the central veins.

Pathogenesis of hemothorax

The accumulation of blood in the pleura can cause compression of the lung and displacement of internal organs, and this leads to the fact that the respiratory surface of the lung is significantly reduced, there are respiratory and hemodynamic disorders. For this reason, hemothorax often develops a clinical picture of hemorrhagic and cardiopulmonary shock, which leads to the fact that the heart and respiratory organs are not working properly.

In the first hours after the blood entered the pleura, the inflammatory process develops in the latter. With hemothorax, it can be determined by the test of Ruvelua-Gregoire (swelling, leukocyte infiltration, swelling and sloughing of mesothelium cells). At first, the blood that has entered the pleura area by bleeding does not differ from peripheral blood, and a little later the hemoglobin level, the index of erythrocytes and leukocytes decrease.

If you get into the pleura, the blood turns off, but after a short time the fibrinolysis process begins, due to which it liquefies again. This process is promoted by anticoagulant factors. There are several classes of hemothorax. What are their differences?

Classes of hemothorax

We have already said that hemothorax can be traumatic, pathological and iatrogenic. In addition, given the strength of bleeding, it is also divided into several classes:

• Small - the accumulation of blood occurs in the sinus, and the volume of blood loss is not more than 500 ml;
• Average - the blood has already descended to the level of 4 ribs, and its volume is about one and a half liters;
• Subtotal - blood descended to the lower level of 2 ribs, and the volume of blood loss is about two liters;
• Total - on the X-ray, the blackout from the side of the pleura lesion is noticeable, and the blood loss is more than the spirit of liters.

In addition, hemothorax, which is determined by the Ruvelois-Gregoire test and other diagnostic methods, can be apical, inter-partisan, paracostal, over-diaphragmatic, paramediastinal, all depending on the site of localization. Also, if the bleeding continues, the hemothorax is called increasing, and if it ceases - stable. If the pleura concurrently receives not only blood, but also air, in this case we are talking about hemopneumovorax. But what symptoms can point to hemothorax?

Signs of hemothorax

The clinical picture depends directly on the intensity of bleeding, squeezing the lung tissue and the displacement of the organs. Small hemothorax may not be accompanied by symptoms, mainly the patient complains of chest pain, which may worsen during coughing, and may appear shortness of breath.

But the middle and large classes, which can be confirmed with the help of the test of Ruvelois-Gregoire, are accompanied by respiratory disorders, cardiovascular disorders and others. To not notice signs at such degree simply it does not turn out, after all there can be a strong pain which amplifies at tussis, delicacy in all body, the arterial pressure decreases. With a little physical exertion, all the symptoms become worse. The patient chooses a comfortable position for himself - sitting or half-sitting.

But with severe hemothorax, there is weakness, which does not allow even to rise, the head turns, tachycardia develops, the skin turns pale, flies flash before your eyes, often there are faints. But not always the symptoms can accurately point to hemothorax, so it's best to contact a doctor who will prescribe a number of studies, including the Ruwluois-Gregoire test. With hemothorax - this is the best method, which in a short time will help to indicate the presence or absence of bleeding.

Diagnostics

During an accurate diagnosis, the doctor clarifies all the details of the disease, and appoints a physical and other methods of examination, including laboratory ones. With hemothorax, you should immediately determine whether there is a lag in the affected side during respiratory movements, whether the percussion sound is blunted over the place where the liquid has collected, whether breathing is weakened, or if there is a trembling of the voice.

X-ray of the lungs reveals lung collapsing, the presence of fluid (patient in the horizontal position during the study), or clots in the pleura. For the purpose of diagnosis and clarification of the diagnosis, pleural puncture with hemothorax can be prescribed, in this case the receipt of blood confirms the diagnosis. To identify the sterile and infected hemothorax, Petrov and Efendiyev samples are made, which allow to assess the transparency and sediment of the aspirate.

A laboratory blood test will determine the number of leukocytes and red blood cells. Other diagnostic methods, such as ultrasound, X-ray, chest CT, diagnostic thoracoscopy, can also be performed.

What allows to determine the sample?

To confirm that the bleeding is continuing or that it has already stopped, it is simply necessary to conduct such a study as the test of Ruwilua-Gregoire. A diagnostic method of this kind involves taking blood from the pleura, and then looking at it. If it folds in a test tube or syringe, it means that the bleeding continues, and if there is no coagulation, then no. Further samples are sent to the laboratory for further investigation, and the amount of hemoglobin is already determined from them.

The positive test of Ruvelua-Gregoire is an indicator to emergency thoracotomy, which will help stop bleeding. This method of diagnosis is informative, but it is better to conduct additional tests in addition to be 100% sure of the diagnosis. But how to make a sample correctly?

Method of sampling puncture with hemothorax

To conduct the test should only a qualified doctor, because this study is very complex, and if you draw a blood sample wrong, you can further damage the patient. Puncture with hemothorax is a unique diagnostic technique that is performed between the 6th and 7th ribs along the mid- and back-axillary lines. At this point the patient should be in a sitting position. Blood is sent to the study, a solution of the antibacterial drug is injected.

Conservative methods of therapy

Conservative treatment helps if mild hemothorax, in this case, use analgesics and haemostatic drugs. Also, a good effect is provided by substitution therapy with urgent blood transfusion if hemothorax is of medium or even severe form. For the treatment of HT infection, fibrinolytic agents are administered, they are also prescribed for the prevention and therapy of coagulated hemothorax, and immunocorrective and symptomatic treatment can also be used.

Small hemothorax very quickly and without consequences can be eliminated by conservative methods of treatment. But in the case when a positive test of Ruvelois-Gregoire was revealed during a second examination, then there is no way to do without surgical intervention.

Surgical treatment of hemothorax

The operation is indicated to the patient in such cases:

• If bleeding continues inside the pleura;
• Hemothorax curled and prevents the spread of the lung;
• If there was a repeated accumulation of blood after taking a puncture;
• There is a discharge of blood through the pleural drainage, and its volume is about 500 ml for 2-3 hours;
• Damaged vital organs.

Treatment of hemothorax is based on the features of the etiological factor, the intensity of bleeding and the severity of hemorrhagic shock. Open penetrating lesions of the lung and other chest organs require urgent surgical intervention against the background of complex anti-shock therapy, which includes not only therapeutic analgesia, but also the struggle with the acute form of anemia and hypoxia.

The operation is necessary for such purposes:

• stop the bleeding;
• Eliminate damage to internal organs;
• Remove excess blood;
• To impose drainage for accelerated lung expansion;
• For the sanitation of the pleural cavity with antiseptics.

But what predictions do doctors give to patients who underwent hemothorax surgery?

Prognosis and prevention of hemothorax

The success of therapy with hemothorax depends on the nature of the trauma or pathology, the intensity of bleeding and timely treatment. A prognosis is favorable for patients with mild or moderate hemothorax. Curated hemothorax may threaten the development of pleural empyema, but the continued bleeding or one-time large blood loss can lead to death.

The consequence of hemothorax can be the formation of massive pleural joints, which lead to a restriction of the mobility of the diaphragm. In this case, it is recommended that all patients who have undergone such a condition, engage in swimming and do regular respiratory gymnastics.

Prevention of hemothorax provides for the prevention of chest injury, consultation with a doctor for patients with thoracoabdominal trauma, control of hemostasis with surgery on the lungs and mediastinum.

Conclusion

To summarize, I want to say that the test of Ruvelua-Gregoire is one of the most important studies in hemothorax. Bleeding in the pleural region is a very serious condition requiring urgent treatment to the doctor. That is why when the first symptoms or immediately after the injury it is better to seek qualified help, otherwise inaction can result in a fatal outcome.