Pulmonary trauma

MEDICAL STUDENTS TRAUMATOLOGY / SURGERY

1. Pulmonary Trauma Wan Muhammad Adam Group 31 5 th year VolGMU

2. Pulmonary injury ( injury to the lung) and injuries involving the pleural space Pulmonary contusion Pulmonary laceration Pneumothorax Hemothorax Hemopneumothorax Pulmonary Hematoma

3. Three Mechanisms of Injury Acceleration/Deceleration Shear on tissue Direct Impact Compression of lung against ribs/sternum (flail chest) RESULTS: CONTUSION, LACERATION, HEMATOMA

4. 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

5. 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.

6. 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

7. Lung Contusion with Rib Fracture

8. Lung Lacerations  is a chest injury in which  lung tissue is torn or cut .  An injury that is potentially more serious thanpulmonary contusion 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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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).

14. Causes P enetrating 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

15. 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

16. Diagnosis P hysical 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.

17. Treatment and management S upplemental oxygen Ventilation Drainage of fluids from the chest cavity .   T horacostomy 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

18. 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

19. 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

20. Complications Respiratory Failure Pneumonia ARDS (Acute respiratory distress syndrome) Pulmonary abscess bronchopleural fistula

21. THANK YOU ! 