Imaging of Combat-Related Thoracic Trauma – Blunt Trauma and Blast Lung Injury

Lichtenberger, John P.; Kim, Andrew M.; Fisher, Dane; Tatum, Peter S; Neubauer, Brian; Peterson, Paul; Carter, Brett W.

doi:10.1093/milmed/usx033

Cited by 29 publications

(11 citation statements)

References 40 publications

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“…Under field circumstances, the incidence of blunt chest trauma is four times higher than under civilian circumstances, in certain situations, pulmonary contusion occurs in nearly 50% of blunt chest trauma cases. Although modern body armours cover a larger body surface and provide an all-around protection and thus, have resulted in a decrease in the number of perforation injuries, the consequences of injuries caused by blunt trauma often fail to get adequate attention (14).…”

Section: Historical Backgroundmentioning

confidence: 99%

Pulmonary contusion

Rendeki¹,

Molnár²

2019

J. Thorac. Dis

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Lung contusion resulting from chest trauma may be present various clinical pictures. It quite often remains unrecognized and is only suspected later when severe complications have developed. Lung contusion may present in association with chest trauma but may also occur alone. It has to be emphasized, that lung contusion as a clinical identity does not necessarily require a blunt or penetrating chest to be in the background. Nowadays, as a result of traffic accidents, following high energy deceleration, lung contusion may present without an actual tissue damage in the chest wall as a condition initiating an independent, lifethreatening generalised process. Although lung contusion shows similarities to blast injury of the lung with respect to clinical consequences, other factors play a role in its aetiology and pathology. Its description and recognition as an independent pathology is not simple. Several approaches exist: thoracic trauma, pulmonary contusion, pulmonary laceration, lung contusion; although these may show similar clinical signs, manifest in different pathologies. Pathologies with similar meaning and possibly similar clinical course cannot, actually, be differentiated; they may accompany other injuries to the trunk, skull or extremities, which, alone, are associated with high morbidity and mortality. Generally, it can be declared that besides high energy, blunt injuries affecting the trunk, lung contusion, has been an often neglected additional radiological finding attached to the main report, despite the fact, that its late consequences crucially determine the prospects of the injured.

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Section: Historical Backgroundmentioning

confidence: 99%

Pulmonary contusion

Rendeki¹,

Molnár²

2019

J. Thorac. Dis

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“…El examen que clásicamente se ha considerado de certeza es la angiografía, tanto para definir el diagnóstico como el lugar de la ruptura. En el ambiente bélico las imágenes de radiografía, tomografía o angiografía son el medio diagnóstico más utilizado [59], [60], [61]. Dado que el paciente politraumatizado es frecuentemente derivado al servicio de radiología para la realización de una tomografía computarizada para la evaluación de un posible TEC y/o trauma abdominal, ésta puede ser usada también para la evaluación de la aorta torácica.…”

Section: Lesiones Vascularesunclassified

Traumatismo torácico y anestesia

Garrido¹

2021

Rev. chil. anest.

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The thoracic trauma patient is generally of young, working age, and is often affected by multiple trauma. In its preoperative management, the functional repercussions secondary to thoracic injuries (pulmonary contusion, myocardial contusion, flail chest, etc.) should be evaluated. These become more important when anesthesia must be administered for surgical resolution of neurological, abdominal or limb injuries, and especially, when emergency thoracic surgery must be performed. Only 15% of patients with chest trauma require surgery. In emergency situations, regional techniques are limited to be a part of the postoperative analgesia or they are indicated in case of extensive nonsurgical parietal lesions. These are patients that have a full stomach in whom, in many cases, a chest drain must be installed prior to or during anesthetic induction. Induction agents that produce less hemodynamic compromise and maintenance with halogenated gases are suggested. Double-lumen endobronchial tubes are the standard method for providing lung isolation. Intraoperative mechanical ventilation should be provided considering the concepts of pulmonary protection taken from intensive medicine. Good postoperative analgesia facilitates respiratory physiotherapy, prevents deterioration of lung function, and allows early ambulation, helping altogether to reduce the incidence of pulmonary and thromboembolic complications.

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“…Ro thoraks menunjukkan gambaran Infiltrat, tanda infiltrat kadang tidak muncul dalam 12-24 jam. 11 Sinar x dada adalah tes lini pertama yang didapat pada trauma thoraks tumpul untuk menilai cedera paru atau toraks. Perlu dilakukan pemeriksaan berulang dan pencitraan lebih lanjut jika gejala terus berlanjut.…”

Section: Pembahasanunclassified

Penatalaksanaan Pasien Dengan Kontusio Paru

Siahaan

Maharani²

2021

JKUPR

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Pendahuluan : Kontusio paru adalah manifestasi trauma tumpul toraks yang paling umum terjadi. Kontusio paru paling sering disebabkan trauma tumpul pada dinding dada secara langsung yang dapat menyebabkan kerusakan parenkim, edema interstitial dan perdarahan yang mengarah ke hipoventilasi pada sebagian paru. Kontusio paru juga dapat menyebabkan hematoma intrapulmoner apabila pembuluh darah besar didalam paru terluka dan memiliki potensial menyebabkan kematian. Proses, tanda dan gejala mungkin berjalan pelan dan makin memburuk dalam 24 jam pasca trauma. Penatalaksanaan pada pasien perlu dilakukan segera dengan memastikan patensi jalan napas, pemberian analgetik, ventilasi mekanik dan terapi pendukung lainnya seperti pemberian antibiotik dan terapi cairan untuk mencegah terjadinya komplikasi yang terjadi. Tujuan : Melaporkan penatalaksanaan kasus kontusio paru di ICU. Laporan Kasus : Seorang pasien laki-laki 56 tahun datang ke IGD RSCAM Bekasi dengan keluhan utama nyeri pada dada kanan dan sesak. 2 hari sebelum masuk RS, pasien terjatuh dari pohon dengan ketinggian + 5 meter. Pasien terjatuh dengan posisi bagian depan tubuh terlebih dahulu. Sesak (+), pingsan, muntah (-), nyeri dada (+). Pasien lalu dibawa ke RS GJ, dilakukan foto toraks dan pemasangan chest tube. Setelah dirawat 2 hari, pasien dirujuk ke IGD RSCAM BEKASI, foto toraks di RS GJ menunjukkan adanya Hematopneumotoraks kanan dan terlihat chest tube pada posisinya. Pasien tiba + pukul 13.42, setelah diobservasi + 6 jam, pasien dikonsulkan ke bagian Anestesi pada pukul 20.00, dan ditemukan kesadaran pasien komposmentis, dengan Tekanan darah 130/90, laju nadi 120x/menit dan frekwensi napas pasien 34-38x/menit (O2 10l/menit dengan NRM), SpO2 88%, VAS (Visual Analog Score) 6-8/10. Pasien kemudian diintubasi atas indikasi Hematopneumotoraks kanan + kontusio paru bilateral + impending gagal napas post CTT + fraktur costae 7-8 aspek posterior kanan, 6 aspek lateral kanan + flail chest. Pasien kemudian dirawat ke ICU. Kesimpulan : Penatalaksanaan pada pasien perlu dilakukan segera untuk mencegah terjadinya komplikasi yang terjadi, yaitu dengan memastikan patensi jalan napas, pemberian analgetik, ventilasi mekanik dan terapi pendukung lainnya seperti pemberian antibiotik dan terapi cairan untuk mencegah terjadinya komplikasi yang terjadi. Kata Kunci : kontusio paru, trauma toraks.

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Imaging of Combat-Related Thoracic Trauma – Blunt Trauma and Blast Lung Injury

Cited by 29 publications

References 40 publications

Pulmonary contusion

Pulmonary contusion

Traumatismo torácico y anestesia

Penatalaksanaan Pasien Dengan Kontusio Paru

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