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

THANK YOU !