PULMONARY CONTUSION AND TRAUMATIC ASPHYXIA

Pulmonary Contusion
Alveolar blood collecting Interstitial bleeding Edema of the lung Structural change of the lung Increase vascular resistance Decrease lung compliance Inflammatory reaction to blood component ARDS (50 60%)

Pulmonary Contusion

Hypoxia and respiratory failure usually due to pulmonary contusion (pulmonary edema), rather than flail chest

Pulmonary Contusion Morbidity/Mortality

May be missed due to the high incidence of other associated injuries
Mortalitybetween 14% and 20%

Pulmonary Contusion
A pulmonary contusion is the most common potentially lethal chest injury.
Incidence
Blunt trauma to the chest The most common injury from blunt thoracic trauma. 30% to 75% of patients with blunt trauma have pulmonary contusion. Commonly associated with rib fracture High-energy shock waves from explosion High-velocity missile wounds Rapid deceleration A high incidence of extrathoracic injuries

Pulmonary Contusion Assessment Findings

Tachypnea Tachycardia Cough Hemoptysis Apprehension Respiratory distress Dyspnea Evidence of blunt chest trauma Cyanosis

Troublesome Injuries
Lung contusion CxR finding may range from minimal interstitial infiltrate to extensive lobar consolidation Chest CT is accurate diagnostic tool but not always mandatory Tx : same as flail chest, but pay attention to avoid overhydration; use of steroid and prophylactic antibiotic are still controversial

PULMONARY CONTUSION

Pulmonary contusion

Treatment of Pulmonary Contusion

Ventilator if signs of pulmonary failure CPAP per mask Circulationrestrict IV fluids (use caution restricting fluids in hypovolemic patients). Epidural narcotics for pain relief Intercostal nerve blocks for pain relief Methylprednisone 30mg/kg If severe pulm contusion: Inhaled anesthesia may increase pulmonary shunting b/c lungs loose ability to autoregulate blood flow effectively Transport considerations

TRAUMATIC ASPHYXIA

Traumatic Asphyxia
Results from sudden compression injury to chest cavity Can cause massive rupture of Vessels and organs of chest cavity Ultimately Death (sudden)

Traumatic Asphyxia
Incidence
A severe crushing injury to the chest and abdomen
Steering wheel injury Conveyor belt injury Compression of the chest under a heavy object

Traumatic Asphyxia Pathophysiology

A sudden compressional force squeezes the chest. An increase in intrathoracic pressure forces blood from the right side of the heart into the veins of the upper thorax, neck, and face. Causes backwards flow of blood from right side of heart into superior vena cava and the upper extremities Jugular veins engorge and capillaries rupture.

Traumatic Asphyxia Assessment

Severe Dyspnea Reddish-purple discoloration of the face and neck (the skin below the face and neck remains pink). Petechiae Jugular vein distention. Swelling of the lips and tongue. Swelling of the head and neck. Swelling or hemorrhage of the conjunctiva (subconjunctival petechiae may appear). Hypotension results once the pressure is released.

Traumatic Asphyxia Management

Airway and Breathing Ensure an open airway. Provide adequate ventilation High Flow oxygen. Circulation IV access (beware SHOCK). Expect hypotension and shock once the compression is released. Care for associated injuries Transport considerations Appropriate mode. Appropriate facility.

BLS Plus Care

Cardiac Monitor Establish IV Access and draw blood samples Airway control including Intubation Rapid transport