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Major Trauma
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Pulmonary contusion➣ Most common potentially lethal chest injury.➣ Risk of worsening associated consolidation and pulmonary oedema.➣ Treat with analgesia, physiotherapy, and oxygenation.➣ Consider respiratory support for a patient with significant hypoxia.
Trauma
Published in Sam Mehta, Andrew Hindmarsh, Leila Rees, Handbook of General Surgical Emergencies, 2018
Sam Mehta, Andrew Hindmarsh, Leila Rees
This is bruising to the lung. Pulmonary contusion may lead to progressive respiratory failure. Ensure adequate pain control and consider intubation and ventilation early if the patient’s clinical condition deteriorates.
Torso trauma
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The natural progression of pulmonary contusion is worsening hypoxaemia for the first 24-48 hours. Chest radiographic findings may be typically delayed. Contrast CT scanning can be confirmatory. Haemoptysis or blood in the endotracheal tube is a sign of pulmonary contusion.
Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study
Published in Expert Review of Respiratory Medicine, 2022
Hela Attia, Helmi Ben Saad, Karim Masmoudi, Imen Bannour, Mouna Ouaz, Kais Gardabbou, Ali Majdoub
In addition to parietal bone fractures, the most painful lesions in chest trauma patients were pleural effusions [11]. Pleural effusion in the presence of rib fractures usually represent hemothorax [11]. In this study, pleural effusions were present in 52% of the patients, and they were found to be predictors of nebulized MOR failure. Pleural effusions are likely to limit chest extension and to increase the respiratory work, leading to similar complications to those in parietal lesions [11]. Pulmonary contusion, in itself, is less algogenic than parietal and pleural lesions, and it is often poorly symptomatic [11,27]. Pulmonary contusion was reported to be a predictor of failure because it impedes the pulmonary diffusion of inhaled molecules, including MOR [27]. The presence of hemothorax and pulmonary contusions are signs of high kinetic energy during the trauma [11,27].
Pulmonary hypoxia and venous admixture correlate linearly to the kinetic energy from porcine high velocity projectile behind armor blunt trauma
Published in Experimental Lung Research, 2021
Ulf P. Arborelius, David Rocksén, Jenny Gustavsson, Mattias Günther
Some limitations need to be discussed. First, the observation time was limited to 60 minutes. The study was designed to determine acute lung function impairments that cause immediate respiratory failure, which is an important aspect of potential treatment targets to prevent death in prehospital or tactical environments. Respiratory mechanics are affected early after pulmonary contusion.18 Future studies may include longer observation times to investigate delayed effects of BABT trauma, which may be characterized by lung hemorrhage, alveolar collapse, pulmonary edema and an inflammatory response18–20 but were beyond the scope of this investigation. Second, the similar size and anatomy of swine organs and human organs allow the model to be particularly beneficial for translational research. For the field of respiratory medicine, the similarities between swine and human lungs give porcine models the potential of advancing translational medicine. However, interspecies differences in lung function, such as decreased pulmonary compliance in swine, may limit extrapolation to humans with BABT.21,22 Third, while the energy calculations represent the first predictions of lethality from BABT based on lung physiology, the findings need to be verified in survival studies. Fourth, it is possible that multiple shots may cause cumulative damage to the rib, which may confound the likelihood for rib fracture in relation to the back-face signature, an aspect which should be explored in future studies.
A rare case of diffuse alveolar hemorrhage caused by acute mycoplasma pneumoniae pneumonia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sarah Schmitz, Matan Arnon, Christina Martin, Nino Kvantaliani, Ho-Man Yeung
Our patient underwent an extensive workup for hemoptysis; trauma, infection, coagulopathy, malignancy, and autoimmune causes were all considered. The mechanical fall raised initial concerns for a pulmonary contusion. Given that the patient was non-mobile, there was also a concern for pulmonary embolism. An infectious etiology was not suspected initially given a lack of fever and leukocytosis and was not considered until further history and additional work-up. Studies have shown that delay in the initiation of antibiotics is associated with the development of fulminant M. pneumoniae and that early recognition and treatment can be lifesaving [5]. Because M. pneumoniae lacks a cell wall, it does not appear on gram stain and does not grow in routine cultures. Although Mycoplasma is known to cause hemolytic anemia, our patient’s clinical presentation was more consistent with an acute bleed given that his hemoglobin stabilized after hemostasis. Mycoplasma has also been reported to cause CNS infection [6], which would be concerning as this patient had a VP shunt. However, our patient had no neurological changes and his mental status was at baseline prior to presentation and after extubation. Another complication of Mycoplasma infection is cold agglutinin cryogloblinemia, which can cause pulmonary hemorrhage [7]. Although this complication was a possibility in our case, the lack of renal failure, a purpuric rash, or petechiae on the skin made it less likely [4].