pulmonary trauma
TRANSCRIPT
Pulmonary Trauma
Wan Muhammad Adam
Group 31
5th year
VolGMU
Pulmonary injury
(injury to the lung) and injuries involving the pleural
space
Pulmonary contusion
Pulmonary laceration
Pneumothorax
Hemothorax
Hemopneumothorax
Pulmonary Hematoma
Three Mechanisms of Injury
Acceleration/Deceleration Shear on tissue
Direct Impact
Compression of lung against ribs/sternum (flail chest)
RESULTS: CONTUSION, LACERATION, HEMATOMA
Lung Contusion
is a contusion (bruise) of the lung, caused by chest
trauma.
As a result of damage to capillaries, blood and other
fluids accumulate in the lung tissue
Does not involve a cut or tear of the lung tissue.
Usually associated with other chest injuries
May be insidious-usually seen on CXR within 6 hours
after admit
Local alveolar flooding and systemic effects
Causes
is usually caused directly by blunt trauma but can also
result from explosion injuries or a shock wave
associated with penetrating trauma.
BLUNT TRAUMA
70% of cases result from motor vehicle collisions
Falls
Assaults
Sports injuries are other causes.
Signs and symptoms Presentation may be subtle people with mild contusion may
have no symptoms at all.
Because gas exchange is impaired, signs of low blood oxygen
saturation, such as low concentrations of oxygen in arterial
blood gas and cyanosis (bluish color of the skin and mucous
membranes)
Dyspnea(painful breathing or difficulty breathing)
Rapid breathing and a rapid heart rate are other signs
With more severe contusions, breath sounds heard through a
stethoscope may be decreased, or rales
People with severe contusions may have bronchorrhea (the
production of watery sputum).
Wheezing and coughing are other signs.
Coughing up blood or bloody sputum
Hypotension
pulmonary contusion tends to worsen slowly over a few days,
but it may also cause rapid deterioration or death if untreated
Lung Contusion with Rib Fracture
Lung Lacerations
is a chest injury in which lung tissue is torn or cut. An injury that is potentially more serious thanpulmonarycontusion
pulmonary laceration involves disruption of the architecture of the lung
May be seen with both penetrating(more common) and with blunt trauma
May involve vessels and/or airways
Pnemothorax/Hemothorax common
The injury commonly heals quickly with few problems if it is given proper treatment
however it may be associated with scarring of the lung or other complications
Classification
4 Types
Type 1 pulmonary laceration (Fig. 2) results from sudden
compression of the pliable chest wall against the closed
glottis, wherein the air-containing parenchyma
ruptures. These are typically large (2–8 cm.) and are
located deep within the pulmonary parenchyma.
Type 2 pulmonary laceration (Fig. 3) occurs from
shearing forces as the lung is squeezed over the
vertebral bodies from rapid compression of the chest
wall. This type of laceration typically occurs in the
paraspinal lung parenchyma and may have an elongated
rather than spherical appearance.
Type 3 pulmonary laceration (Fig. 4) is a penetrating
injury caused by puncture from a fractured rib fragment
and typically appears as a small peripheral lucency
intimately associated with an adjacent rib fracture.
These types of injuries are often multiple.
Type 4 pulmonary laceration is the result of a previously
formed, firm pleuropulmonary adhesion causing the
lung to tear when the overlying chest wall is violently
compressed inward or is fractured. This type is almost
always identified only at surgery or autopsy.
A pulmonary laceration can cause air to leak out of the
lacerated lung and into the pleural space, if the
laceration goes through to it.
Pulmonary laceration invariably results in
pneumothorax (due to torn airways),
hemothorax (due to torn blood vessels),
Hemopneumothorax (with both blood and air in the chest
cavity).
Causes
Penetrating trauma
blunt trauma; broken ribs may perforate the lung, or the tissue may be
torn due to shearing forces
Violent compression of the chest can cause lacerations by rupturing or
shearing the lung tissue.
may be associated with pulmonary contusion.
As with contusions, pulmonary lacerations usually occur near solid
structures in the chest such as ribs.
Pulmonary laceration is suspected when rib fractures are present
Lung Hematoma
Pulmonary hematoma is a collection of blood within the tissue of
the lung. It may result when a pulmonary laceration fills with blood. A lung
laceration filled with air is called a pneumatocele
May show up in first 72 hours
Often resolves spontaneously
Diagnosis
Physical examination
Information about the event that caused the injury
radiography.
Chest X-ray
Computed tomography
ultrasound
Laboratory findings may also be used; for example,
arterial blood gasses may show insufficient oxygen and
excessive carbon dioxide even in someone receiving
supplemental oxygen.
Treatment and management
Supplemental oxygen
Ventilation
Drainage of fluids from the chest cavity.
Thoracostomy tube can be used to remove blood and air from the chest cavity.
About 5% of cases require surgery, called thoracotomy.
Thoracotomy is especially likely to be needed if a lung fails to re-expand; if pneumothorax, bleeding, or coughing up blood persist; or in order to remove clotted blood from a hemothorax.
Surgery
Surgical Treatment
Surgical treatment includes
Suturing
Stapling
Oversewing
wedging out of the laceration.
• Depending on situations surgeons must perform a lobectomy, in
which a lobe of the lung is removed, or a pneumonectomy, in
which an entire lung is removed
Management is pain control-epidural, nerve blocks,
PCA(Patient-controlled analgesia) anesthesia along with
supportive care (fluids and O2).
Positive pressure ventilation for flail chest
Complications
Respiratory Failure
Pneumonia
ARDS (Acute respiratory distress syndrome)
Pulmonary abscess
bronchopleural fistula
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