La contusión pulmonar es la lesión visceral más frecuente. Suele presentarse en TT graves y a menudo asociada a otras lesiones torácicas e intratorácicas. Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of. World J Surg. Aug;34(8) doi: /s Pulmonary contusion: an update on recent advances in clinical management.
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Verh Dtsch Ges Pathol. Current Opinion in Anaesthesiology. There may be hypotension and reduced cardiac output. Management Most contusions will require no specific therapy as such. Clearance of secretions is decreased with pulmonary contusion, and this is augmented by any chest wall injury and mechanical ventilation.
These injuries damage alveolar capillaries, so blood and other fluids accumulate in the lung tissue, but it does not involve a cut pulmmonar a tear of the lung tissue. Case 2 Case 2.
Pathogenesis and effect of various resuscitative measures. Emerg Med J, 22pp. However the chest X-ray will often under-estimate the size of the contusion and tends to lag behind the clinical picture. Compartmentalized lung cytokine release in puljonar to intravascular and alveolar endotoxin challenge. With the use of explosives during World Wars I and II, pulmonary contusion resulting from blasts gained recognition.
ARDS after R pulmonary contusions.
As the physiological impact of the ocntusions tends to develop over hours, close monitoring is required and supplemental oxygen should be administered.
Injuries to the chest wall are also distinct from but may be associated with lung injuries.
As the mismatch between ventilation and perfusion grows, blood oxygen saturation is reduced [ 55 ]. Seminars in Roentgenology 41 3: Introduction to Sports Medicine and Athletic Training. Alveolar recruitment in combination with sufficient positive end expiratory pressure increases oxygenation and lung aeration in patients with severe chest trauma. T cells have been associated with BOOP-associated fibrosis, and these immune cells may contribute to the pathology and resolution of isolated lung contusion [ 3546 ].
Thoracic Trauma and Critical Care. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact. Three possible mechanisms of development of contusion are:. Proc Am Thorac Soc. Compartmentalization of intraalveolar and systemic lipopolysaccharide-induced tumor necrosis factor and the pulmonary inflammatory response.
Recommendations of Diagnosis and Treatment of Pleural Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance. While contusion can affect anyone, children are considered more susceptible due to greater pliability of the chest wall in that age group, especially to pulmonary laceration.
Many of these patients will also have a significant chest wall injury, pain from which will affect their ability to ventilate and to clear secretions. Retrieved 18 June CT also allows for 3-dimensional assessment and calculation of the size of contusions. Imaging of thoracic injuries. Pulmonary ultrasoundperformed at the bedside or on the accident scene, is being explored as a diagnosis for pulmonary contusion.
Compartmentalized cytokine production within the human lung in unilateral pneumonia.
: Thoracic Trauma
Management of a blunt chest injury therefore includes adequate and appropriate analgesia. An inactivation and reduction in the amount of surfactant increase alveolar surface tension which subsequently may cause collapse and consolidation of the alveoli [ pylmonar28 ].
In addition to blunt traumapenetrating trauma can cause pulmonary contusion. Acute Inflammatory Response to Acute Lung Injury The innate inflammatory response due to direct or indirect insults to the contueion involves recruitment of blood leukocytes, tissue macrophage activation, and the production of a series of mediators including cytokines, chemokines, oxygen radicals, arachidonic acid metabolites and components of the complement and coagulation cascades [ 3334 ].
TLR-2 and TLR-4 have recently been shown to involve in the pathogenesis of pulmonary contusion in murine models [ 4243 ]. The mechanism of injury may suggest blunt chest trauma, and there pulmlnar be obvious signs of chest wall trauma such as bruising, rib fractures or flail chest. Core puulmonar for pediatric emergency nursing.
Smith M, Ball V. The administration of fluid therapy in individuals with pulmonary contusion is controversial. Chest trauma Medical emergencies Lung disorders.
Most significant pulmonary contusions are diagnosed on plain chest X-ray, but the chest Plmonar often underestimate the size of contusion and usually lags behind the clinical picture.
Often the true extent of injury is not contuusion on plain films until hours following injury. Classification of parenchymal injuries of the lung. Edit article Share article View revision history.
These injuries are usually found in severe chest pupmonar and are often associated with other thoracic and intrathoracic lesions. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Normally, the ratio of ventilation to perfusion is about one-to-one; the volume of air entering the alveoli ventilation is about equal to that of blood in the capillaries around them perfusion. Opening up to lung recruitment, pulmonary contusion and derecruitment-the role of inflammation.