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Chapter-14 Injuries of Lungs and Pleura

BOOK TITLE: Principles and Practice of Trauma Care

Author
1. Kochar SK
ISBN
9789350257173
DOI
10.5005/jp/books/11942_14
Edition
2/e
Publishing Year
2013
Pages
16
Author Affiliations
1. Royal Hospital, Greenock, Scotland, UK, Army Base Hospital, New Delhi, India, Fortis Heart Institute and Multispeciality Hospital, Mohali, Punjab, India
Chapter keywords

Abstract

Injuries to lungs and pleura are second in incidence to injuries to chest wall. Injuries to lungs and pleura can be classified as immediately life threatening and potentially life threatening. Mechanism of injuries may be direct impact, compression/crushing, acceleration/deceleration and high speed impact. It may be blunt or penetrating. Classically blunt injuries to the lungs have been grouped into: lacerations, haematomas, contusions. Management of pulmonary conusion consist of aggressive pulmonary care with chest physical therapy, turning of the patient in bed, ambulation, endotracheal suctioning, and bronchoscopy. Pain relief with local intercostal block or epidural analgesia, intravenous fluid administration with CVP monitoring and systemic antibiotics. Pulmonary contusion has been classified as group I to III depending on severity of lesion. Penetrating injuries may result in open pneumothorax, haemo pneumothorax and various degrees of pulmonary lacerations. Presentation is as circulatory collapse or respiratory distress of variant degree. Initial management is to have haemodynamic stability followed by tube thoracostomy. This is all that may be needed in 80% of patients and indication of thoracotomy are Initial loss more than 1000 ml, continuous loss > 200 ml/hr for 4 hr, and Bright red colour blood. Surgical evacuation of clotted haemothorax may be required. The exact incidence of posttraumatic empyema is not known but incidence is higher in penetrating injuries than blunt injuries. In some cases of empyema, tube thoracotomy often provides adequate treatment. Surgical intervention early in the course of the disease is easier, response is good and complications are less. Posterolateral thoracotomy is ideal approach. Pulmonary laceration has been classified into four types on the basis of CT scan. Pulmonary lacerations following blunt injury is managed on the lines of management of pulmonary contusions. Pulmonary lacerations following stab injuries/gun-shot wounds result in haemothorax and/or pneumothorax. Most of these injuries are easily managed with tube thoracotomy.

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