Traumatic Lung Disorders

Question 1

penetrating chest trauma

Answer 1

*foreign object that:
-pierces the skin
-enters the chest cavity with underlying organ injury
-leaves an open wound
*most common etiologies: gunshot wound, stabbing

Question 2

penetrating chest trauma - associated injuries

Answer 2

*variable associated injuries, including:
-cardiac tamponade → cardiac arrest
-hemothorax
-pneumothorax
-tension pneumothorax
-tracheobronchial injury
-diaphragmatic injury
-rib fractures
-vascular injuries
-spinal cord injuries

Question 3

penetrating chest trauma - clinical features

Answer 3

*hemorrhagic shock
*respiratory distress or failure
*absent or decreased breath sounds
*penetrating chest wound, “sucking chest wound”
*impaled foreign object
*tracheal deviation
*PNEUMOTHORAX or TENSION PNEUMO

Question 4

tension pneumothorax

Answer 4

*accumulation of air in pleural space
*increasing trapped air → tension pneumo
*trachea deviates away from affected lung
*may lead to increased intrathoracic pressure → mediastinal displacement → kinking of IVC → decreased venous return → decreased cardiac output, obstructive shock (hypotension, tachycardia), jugular vein distention
*needs immediate needle decompression and chest tube placement

Question 5

penetrating chest trauma - diagnosis

Answer 5

*history
*CXR
*eFAST (bedside ultrasound)
*CT chest (CTA if concerns for vascular injury)
*bronchoscopy if tracheoesophageal injury suspected
*echocardiogram for tamponade

Question 6

penetrating chest trauma - treatment

Answer 6

*treat underlying injuries
*3-way occlusive dressing treats the open wound:
-on inspiration, dressing seals wound, preventing air entry
-expiration allows trapped air to escape through untaped section of dressing

*if tension pneumo → needle decompression and chest tube placement
*emergent thoracotomy if patient is unstable

Question 7

chest blunt force trauma

Answer 7

*non-penetrating chest wounds
*common etiologies:
-motor vehicle crash (airbags, steering wheel, seat belt)
-vehicle-pedestrian crash
-struck by an object
-fall from height
-bike injuries
-assault

Question 8

chest blunt force trauma - associated injuries

Answer 8

*chest wall injury/rib fractures and “flail chest”
*aortic rupture
*esophageal tear
*pulmonary contusion
*hemothorax
*pneumothorax
*cardiac injury

Question 9

chest blunt force trauma - pulmonary contusion

Answer 9

*injury associated with localized ISCHEMIA/EDEMA to lung tissue
*if vascular structures of the chest wall are involved, there can be a mass effect (tension pneumo)
*PFTs would show decreased DLCO, decreased TLC, decreased lung compliance

Question 10

chest blunt force trauma - diagnosis

Answer 10

*history
*chest imaging (CXR or CT)
*EKG
*echocardiogram
*bronchoscopy

Question 11

chest blunt force trauma - management

Answer 11

*close monitor of vital signs, esp respiratory status
*risk of progressive repsiratory failure, esp with pulmonary contusion
*treat any underlying complications
*emergent thoracotomy if patient is unstable

Question 12

drowning - defined

Answer 12

*respiratory impairment from submersion or immersion in a liquid
-submersion: victim’s airway goes below the surface of the liquid
-immersion: liquid splashes into the airway of the victim