Cutting of the lung, also known as bruised lung , is a bruised lung, caused by chest trauma. Due to capillary damage, blood and other fluids accumulate in the lung tissue. Excess fluid interferes with gas exchange, potentially causing inadequate oxygen levels (hypoxia). Unlike lung pulmonary, other types of lung injury, lung contusions do not involve injury or tearing of the lung tissue.
Lung bruises are usually caused directly by blunt trauma but can also be caused by an explosive injury or shock wave associated with penetrating trauma. By using explosives during World War I and II, the bruised lung from the explosion got recognition. In the 1960s its emergence among civilians began to gain wider recognition, in which cases were usually caused by traffic accidents. The use of seat belts and airbags reduces the risk for passenger vehicles.
Diagnosis is made by studying the causes of injury, physical examination and chest radiography. Typical signs and symptoms include immediate effects of physical trauma, such as chest pain and coughing up blood, as well as signs that the body is not receiving enough oxygen, such as cyanosis. The bruises often heal themselves with supportive care. Often no more than supplemental oxygen and rigorous monitoring is required; However, intensive care may be necessary. For example, if breathing is greatly disturbed, mechanical ventilation may be necessary. Fluid replacement may be necessary to ensure adequate blood volume, but fluids are given with caution because excess fluid may aggravate pulmonary edema, which may be lethal.
The severity ranges from mild to severe: small contusions may have little to no health impact, but bruising is the most common type of trauma most commonly. This occurs in 30-75% of severe chest injuries. The risk of death after lung bruising is between 14-40%. Pulmonary bruising is usually accompanied by other injuries. Although related injuries are often the cause of death, a lung bruise is thought to cause direct death in a quarter to half of cases. Children are at very high risk for injury because of the relative flexibility of their bones preventing the chest wall from absorbing strength from impact, causing it to be transmitted to the lungs. Lung bruises are associated with complications including pneumonia and acute respiratory distress syndromes, and may cause long-term respiratory distress.
Video Pulmonary contusion
Classification
Pulmonary contusions and lacerations are injuries to the lung tissue. Laseration of the lung, where the lung tissue is torn or cut, differs from the bruised lung in the former involving macroscopic architectural impairment of the lung, while the latter is not. When laceration is full of blood, the result is a pulmonary hematoma, a collection of blood in the lung tissue. Contusion involves bleeding in the alveoli (a small air filled sac that is responsible for absorbing oxygen), but the hematoma is a separate blood clot that is not interspersed with lung tissue. A collapsed lung can occur when the pleural cavity (the space outside the lungs) accumulates blood (hemothorax) or air (pneumothorax) or both (hemopneumothorax). This condition does not inherently involve damage to the lung tissue itself, but they may be related to it. Injuries to the chest wall are also different from but may be associated with lung injury. Chest wall injuries include rib fractures and chest cord, where several ribs are broken so that the rib segment is released from the rest of the chest wall and moves independently.
Maps Pulmonary contusion
Signs and symptoms
Presentation may be subtle; people with mild bruising may not have any symptoms at all. However, bruising of the lung is often associated with signs (objective indications) and symptoms (subjective state), including those indicating the lung injury itself and the accompanying injury. Because gas exchange is disrupted, signs of low blood oxygen saturation, such as low concentrations of oxygen in arterial blood gases and cyanosis (the bluish color of the skin and mucous membrane) are commonly associated. Dyspnea (painful breathing or difficulty breathing) is often noticeable, and tolerance for exercise can be lowered. Rapid breathing and rapid heartbeat are other signs. With more severe contusions, breathing sounds that may be heard through a stethoscope may decrease, or rales (an abnormally crackling sound in the chest accompanying breathing) may exist. People with severe contusions may have bronchorrhea (production of watery phlegm). Wheezing and coughing are another sign. Coughing blood or bloody sputum present in up to half of cases. Cardiac output (the volume of blood pumped by the heart) can be reduced, and hypotension (low blood pressure) is often present. The chest wall area near the bruised wound may feel soft or painful due to related chest wall injury.
Signs and symptoms take time to develop, and as many as half of cases show no symptoms in the initial presentation. The more severe the injury, the faster the symptoms become real. In severe cases, symptoms can occur as soon as three or four hours after trauma. Hypoxemia (low oxygen concentration in arterial blood) usually gets worse for 24-48 hours after injury. In general, bruising of the lungs tends to worsen slowly for several days, but it can also cause rapid damage or death if untreated.
Cause
Pulmonary contusions are the most common injuries found in blunt trauma, occurring in 25-35% of cases. It is usually caused by rapid decelerations that occur when the moving chest attacks a fixed object. Approximately 70% of cases occur due to motor vehicle collisions, most often when the chest hit the inside of the car. Falling, attack, and sports injuries are other causes. Lung bruising can also be caused by an explosion; organs most vulnerable to explosion injuries are gaseous organs, such as the lungs. Lung blast is a severe lung bruise, bleeding, or edema with damage to the alveoli and blood vessels, or a combination of these. This is the leading cause of death among people who initially survived the explosion. Unlike other injury mechanisms where pulmonary bruises are often found alongside other injuries, an explosion can cause lung bruising without damaging the chest wall.
In addition to blunt trauma, penetrating trauma can cause bruising of the lung. Contusions resulting from penetration by fast moving projectiles usually circle the road along which projectiles travel through the network. Pressure waves force the network out of the way, creating a temporary cavity; the network is ready to move back into place, but it is damaged. The contusions of pulmonary accompanying gunshot wounds and knives are usually not severe enough to have a major effect on yield; penetrating trauma causes less extensive lung damage than blunt trauma. Exceptions are gunshot wounds, which can seriously damage large areas of lung tissue through the mechanism of an explosive injury.
Mechanism
The physical process behind the bruised lung is poorly understood. However, it is known that the lung tissue can be destroyed when the chest wall bends into the collision. Three other mechanisms may have been suggested: inertial effects, spalling effects, and explosive effects.
- In the effect of inertia , a lighter alveolar tissue is shaved from a heavier hilum structure, an effect similar to axonal axial injury in head injury. This results from the fact that different networks have different densities, and therefore different acceleration or deceleration rates.
- In the effect of spalling , a burst of lung tissue or shaved in which shock waves fill the lung tissue, at the interface between gas and liquid. Alveolar walls form like a gas-liquid interface with air in the alveoli. Spalling effects occur in areas with large density differences; particles from denser tissue are crushed (disposed) into less dense particles.
- The explosive effect occurs when a pressure wave passes through a network containing bubbles of gas: the first bubble bursts, then bounces and extends beyond its original volume. Air bubbles cause many small explosions, resulting in tissue damage; overexpansion of stretched gas bubbles and tears of alveoli. This effect is thought to occur microscopically when the pressure in the airways increases sharply.
Contusions usually occur in the lungs directly beneath the impact site, but, as with traumatic brain injury, contrecoup contusions can occur in locations opposite to their effects as well. Blows to the front of the chest can cause bruises in the back of the lungs because the shock waves flow across the chest and touch the back of the curved chest wall; this reflects energy to the back of the lungs, concentrating it. (A similar mechanism can occur in the front of the lung when the back is hit.)
The amount of energy transferred to the lungs is determined in large part by the adherence (flexibility) of the chest wall. Children's chests are more flexible because their ribs are more elastic and there is less hardening of their intercostal cartilage. Therefore, their chest wall is curved, absorbing less power and sending more to the underlying organs. The more reinforced adult chest walls absorb more of the power itself rather than transmit it. Thus children usually get lung contusions without fractures on it, while older people are more likely to suffer fractures than contusions. One study found that lung contusions were accompanied by fractures of 62% of the time in children and 80% of the time in adults.
Pathophysiology
Lung bruises produce bleeding and leakage of fluid to the lung tissue, which can become stiff and lose its normal elasticity. The water content of the lungs increases during the first 72 hours after the injury, potentially causing a bright lung edema in a more serious case. As a result of this and other pathological processes, bruising of the lungs progresses over time and can lead to hypoxia (inadequate oxygen).
Bleeding and edema
In the contusions, the capillary tears release fluid to the tissue around them. The membrane between alveoli and capillary is torn; damage to the capillary-alveolar membrane and small blood vessels causes blood and fluid to leak into the alveoli and the interstitial space (space around the cells) of the lungs. With more severe trauma, there is more edema, bleeding, and tearing of the alveoli. Lung bruises are characterized by microhemorrhages (small bleeding) that occur when the alveoli is traumatically separated from the airway and blood vessel structures. Initially, blood collects in the interstitial space, and then the edema occurs an hour or two after the injury. An area of ​​bleeding in the spreading lung is usually surrounded by an edema region. In normal gas exchange, carbon dioxide diffuses across the capillary endothelium, the interstitial space, and across the alveolar epithelium; oxygen diffuses in the other direction. Liquid accumulation disrupts gas exchange, and may cause the alveoli to fill with protein and collapse due to edema and bleeding. The larger the area of ​​injury, the more severe respiratory disorders.
Consolidate and collapse
Lung bruising can cause the lung part to consolidate, the alveoli become collapsed, and atelectasis (partial or total lung collapse) occurs. Consolidation occurs when the normally filled airborne lung parts are filled with material from pathological conditions, such as blood. For several hours after the injury, the alveoli in the injured area thickens and may become consolidated. The decrease in the amount of surfactant produced also contributes to the collapse and consolidation of the alveoli; Surfactant inactivation increases its surface tension. A reduction in surfactant production may also occur in the surrounding tissues that are not originally injured.
Inflammation of the lungs, which can occur when blood components enter the tissue due to bruises, can also cause the lung part to collapse. Macrophages, neutrophils, and other inflammatory cells and blood components can enter the lung tissues and release the factors that cause inflammation, increasing the likelihood of respiratory failure. In response to inflammation, excess mucus is produced, potentially entering the lung part and causing its collapse. Even when only one side of the chest is injured, inflammation can also affect other lungs. Unsurprised lung tissue can cause edema, thickening of the alveoli septa, and other changes. If the inflammation is severe enough, it can lead to lung dysfunction as seen in acute respiratory distress syndrome.
Ventilation/perfusion mismatch
Normally, the ratio of ventilation to perfusion is about one to one; the volume of air entering the alveoli (ventilation) is almost equal to the volume of blood in the capillaries around them (perfusion). This ratio is reduced in lung bruising; fluid filled alveoli can not fill with air, oxygen does not fully meet the hemoglobin, and blood leaves the lungs without full oxygenation. Inadequate lung inflation, which may result from inadequate mechanical ventilation or associated injuries such as flail chest, may also contribute to ventilation/perfusion mismatch. When the mismatch between ventilation and perfusion grows, blood oxygen saturation decreases. Pulmonary hypoxic vasoconstriction, in which the blood vessels near the hypoxic alveoli narrow (narrow in diameter) in response to low oxygen levels, may occur in pulmonary contusions. Vascular resistance increases in the contracted lung part, which causes a decrease in the amount of blood flowing into it, directing blood to a better ventilated area. Although reducing blood flow to unventilated alveoli is a way to compensate for the fact that blood passing through the unventilated alveoli is not oxygenated, blood oxygenation remains lower than normal. If severe enough, hypoxemia produced from fluid in the alveoli can not be repaired simply by providing additional oxygen; this problem is the cause of most casualties caused by trauma.
Diagnosis
To diagnose pulmonary contusions, health professionals use guidance from physical examination, information about the events that cause injury, and radiography. Laboratory findings can also be used; for example, arterial blood gas may indicate insufficient oxygen and excessive carbon dioxide even in someone who receives supplemental oxygen. However, blood gas levels may indicate no abnormality at the start of a pulmonary bruise.
X-ray
Chest X-rays are the most commonly used method for diagnosis, and can be used to confirm diagnoses that have been made using clinical signs. The consolidated area looks white on an X-ray film. Contusion is usually not limited by the anatomical boundary of the lobe or lung segment. X-ray bruises are similar to aspiration, and the presence of hemothorax or pneumothorax may obscure bruises on radiography. Signs of bruising that progress after 48 hours post-injury tends to be completely due to aspiration, pneumonia, or ARDS.
Although chest radiographs are an important part of the diagnosis, it is often not sensitive enough to detect the initial condition after injury. In one-third of the cases, lung bruises were not seen on the first chest radiographs performed. It takes an average of six hours for a typical white area to appear on chest X-rays, and bruises may not be visible for 48 hours. When the bruised lung is apparent in X-rays, it indicates that trauma to the chest is severe and that a CT scan may reveal another injury missed with X-rays.
Computed tomography
Computed tomography (CT scan) is a more sensitive test for lung bruising, and can identify stomach, chest, or other injuries that accompany bruises. In one study, chest x-rays detected pulmonary contusions in 16.3% of people with serious blunt trauma, while CT detected them in 31.2% of the same person. Unlike X-rays, CT scans can detect bruises almost immediately after injury. However, in both X-ray and CT bruising may become more noticeable during the first 24-48 hours after trauma such as bleeding and edema into the progression of lung tissue. CT scans also help determine the size of the bruise, which is useful in determining whether the patient requires mechanical ventilation; Lung volumes contracting larger on CT scans are associated with increased likelihood of increased ventilation. CT scans also help differentiate between bruising and pulmonary hematoma, which may be difficult to distinguish. However, pulmonary contusions seen in CT but not chest x-rays are usually not severe enough to affect outcome or treatment.
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Pulmonary ultrasound, performed at the bedside or at the crash site, is being explored as a diagnosis for bruising. Its use is still not widespread, limited to convenient facilities with its use for other applications, such as pneumothorax, airway management, and hemotoraks. Accuracy has been found to be comparable to CT scanning.
Prevention
Prevention of lung bruises is similar to other chest trauma. Airbags combined with seat belts can protect the occupants of the vehicle by preventing the chest from striking the inside of the vehicle during a collision, and by distributing the forces involved in accidents more evenly throughout the body. However, in rare cases, the airbag causes a bruised lung to someone who is not positioned properly when it spreads. Child controls such as carcass protect children in car crashes due to bruising. Equipment is there for use in some sports to prevent chest and lung injury; for example, in a softball catcher equipped with a chest protector. Athletes who do not wear such equipment, such as basketball players, can be trained to protect their chests from impact. Protective clothing can also prevent bruising of the lungs in an explosion. Although traditional body armor made of rigid plates or other heavy materials protects from projectiles produced by explosions, it does not protect against bruised lung, as it does not prevent shock waves of explosions being transferred to the lungs. Special body armor has been designed for high-risk military personnel for blast injuries; these clothes can prevent shock waves from being spread across the chest wall to the lungs, and thus protect the wearer from an explosive lung injury. This garment replaces the material layer with high and low acoustic impedance (product of material density and wave velocity through it) to "separate" the explosive wave, preventing its propagation into the network.
Treatment
There is no known treatment to speed healing of bruised lung; primary care support. Attempts are made to locate injuries that accompany bruises, to prevent additional injuries, and to provide supportive care while waiting for bruises to heal. Monitoring, including tracking fluid balance, respiratory function, and oxygen saturation using pulse oximeter is also necessary as the patient's condition worsens. Monitoring for complications such as pneumonia and acute respiratory distress syndrome is essential. Treatment aims to prevent respiratory failure and ensure adequate blood oxygenation. Additional oxygen may be given and may be warmed and moisturized. When the bruises do not respond to other treatments, extracorporeal membrane oxygenation can be used, pumping blood from the body to the oxidizing machine and removing carbon dioxide before pumping it back.
Ventilation
Positive pressure ventilation, in which air is forced into the lungs, is required when oxygenation is significantly impaired. Noninvasive positive pressure ventilation including continuous positive airway pressure (CPAP) and second rate positive air pressure (BiPAP), can be used to increase oxygenation and treat atelectasis: air is blown into the airways at the pressure determined through the face mask. Non-invasive ventilation has an advantage over invasive methods because it does not carry the risk of intubation infection, and allows normal coughing, swallowing, and speaking. However, this technique can lead to complications; it can force air into the stomach or cause aspiration of the stomach contents, especially when the level of consciousness decreases.
People with inadequate signs of respiration or oxygenation may need to be intubated and mechanically ventilated. Mechanical ventilation aims to reduce pulmonary edema and increase oxygenation. Ventilation can reopen the collapsed alveoli, but it is dangerous for them to be opened repeatedly, and positive pressure ventilation can also damage the lungs in excess. Intubation is usually reserved when breathing problems occur, but the most significant contusions do require intubation, and it can be done early to anticipate this need. Persons with severe lung bruising may require ventilation including those with previous severe lung disease or kidney problems; parents; those with low awareness; those with low blood oxygen or high levels of carbon dioxide; and those who will undergo surgery with anesthesia. A larger bruise injury correlates with the need for ventilation for longer periods of time.
Lung bruising or its complications such as acute respiratory distress syndrome can cause the lungs to lose adherence (stiffness), so higher pressure may be required to provide normal amounts of air and oxygenate of blood to taste. The positive end-expiratory pressure (PEEP), which gives air at a certain pressure at the end of the expiratory cycle, can reduce edema and keep the alveoli from collapse. PEEP is considered necessary by mechanical ventilation; However, if the pressure is too great, it can increase the size of the bruise and injure the lungs. When wounded lung compliance differs significantly from unharmed, the lungs can be ventilated independently with two ventilators to provide air at different pressures; this helps avoid injury from overinflation while providing adequate ventilation.
Liquid therapy
Providing fluid therapy to individuals with bruised lung is controversial. Excessive fluid in the circulatory system (hypervolemia) may exacerbate hypoxia as it may cause leakage of fluid from the injured capillary (pulmonary edema), which is more permeable than normal. However, low blood volume (hypovolaemia) resulting from a lack of fluid has an even worse effect, potentially leading to hypovolemic shock; for people who have lost a lot of blood, fluid resuscitation is required. Much evidence supports the idea that fluids should be withheld from people with bruised lung originating from animal studies, not clinical trials with humans; research on humans has conflicting findings about whether fluid resuscitation worsens the condition. Current recommendations suggest giving enough fluids to ensure adequate blood flow but not giving more fluids than necessary. For people who do need large amounts of intravenous fluids, catheters can be placed in the pulmonary artery to measure the pressure inside them. Measuring pulmonary artery pressure allows doctors to provide enough fluids to prevent shock without exacerbating edema. Diuretics, drugs that increase the output of urine to reduce excess fluid in the system, can be used when excess fluid occurs, as long as there is no significant risk of shock. Furosemide, a diuretic used in the treatment of bruised lung, also relaxes smooth muscle in the pulmonary vasculature, thus reducing pulmonary venous resistance and reducing pressure on pulmonary capillaries.
Supportive care
Maintaining secretions in the airways can exacerbate hypoxia and cause infection. Thus, an important part of treatment is the pulmonary lung, the use of straws, deep breathing, coughing, and other methods of removing matter such as mucus and blood from the airways. Chest physical therapy uses techniques such as breathing exercises, coughing stimulation, suction, percussion, movement, vibration, and drainage to clear the lungs of secretions, increase oxygenation, and expand the collapsed lung parts. People with bruised lung, especially those who do not respond well to other treatments, can be positioned with a lower unharmed lung than the wounded to increase oxygenation. Inadequate lung toilets can cause pneumonia. People who develop the infection are given antibiotics. No studies have demonstrated the benefits of using antibiotics as a precaution before infection occurs, although some doctors do recommend the use of prophylactic antibiotics even without scientific evidence of its benefits. However, this may lead to the development of antibiotic resistant strains of bacteria, so antibiotics without obvious needs are usually not recommended. For people at high risk of infection, sputum may be cultured to test for the presence of infectious bacteria; when they are present, antibiotics are used.
Pain control is another way to facilitate the elimination of secretions. A chest wall injury can make a painful cough, increasing the likelihood that secretions will accumulate in the airway. Chest injury also contributes to hypoventilation (inadequate breathing) because the chest wall movement involved in breathing is quite painful. Inadequate chest expansion can cause atelectasis, further reducing blood oxygenation. Analgesics (pain medication) can be given to relieve pain. Injection of anesthesia into the nerves in the chest wall, called nerve blockade, is another approach to pain management; This does not diminish respiration as a pain medication.
Prognosis
Pulmonary bruising usually resolves on its own without causing permanent complications; but may also have long-term pain effects on respiratory function. Most contusions recover within five to seven days after injury. Signs detected by radiography usually disappear within 10 days after injury - when not, other conditions, such as pneumonia, are a possible cause. Chronic lung disease correlates with the size of the bruise and may impair the ability of individuals to return to work. Lung fibrosis may occur, resulting in dyspnea (shortness of breath), low blood oxygenation, and reduced functional residual capacity for six years after injury. Up to four years post-injury, a decrease in functional residual capacity has been found in most lung-exposed patients studied. For six months after bruising, up to 90% of people have difficulty breathing. In some cases, dyspnea persists for an indefinite period. Contusion can also permanently reduce lung compliance.
Complications
Lung bruising can cause respiratory failure - about half of cases occur within hours of early trauma. Other severe complications, including infection and acute respiratory distress syndrome (ARDS) occur in up to half of cases. Elderly people and those who have heart disease, lung, or kidney before injury are more likely to stay longer in the hospital and have complications from injury. Complications occur in 55% of people with heart or lung disease and 13% of those who do not. Of people with bruised lung alone, 17% developed ARDS, while 78% of people with at least two additional injuries developed the condition. Larger salting is associated with an increased risk. In one study, 82% of people with 20% or more of lung volume were exposed to ARDS, while only 22% of people with less than 20% did.
Pneumonia, another potential complication, develops in as many as 20% of people with pulmonary bruising. The spreading lungs are less able to remove bacteria than the unharmed lungs, which make them susceptible to infection. Intubation and mechanical ventilation further increase the risk of pneumonia; The tube is passed through the nose or mouth to the airways, potentially tracing bacteria from the mouth or sinus into it. In addition, intubation prevents coughing, which will clear bacterial-filled secretions from the airways, and secretion of the pond near the cuff cuff and allow the bacteria to grow. The faster the endotracheal tube is removed, the lower the risk of pneumonia, but if it is removed too early and should be reentered, the risk of pneumonia increases. People at risk for pulmonary aspiration (eg those with low consciousness due to head injury) are very likely to be exposed to pneumonia. Like ARDS, the likelihood of developing pneumonia increases with bruising size. Children and adults have been found to have the same complication rate as pneumonia and ARDS.
Related injuries
A large number of forces are required to cause pulmonary bruising; an injured person with such power is likely to have another type of injury as well. In fact, bruised lung can be used to measure the severity of trauma. Up to three-quarters of cases accompanied by other chest injuries, the most common are hemotoraks and pneumothorax. Flail chest is usually associated with significant pulmonary contusions, and bruising, rather than chest wall injury, is often the leading cause of respiratory failure in people with this injury. Other indications of thoracic trauma may be associated, including sternal fractures and bruises on the chest wall. More than half of the scapula fractures are associated with pulmonary bruising. The bruises are often found on the underlying fracture site. When accompanied by a fracture, it is usually concentrated to a specific location - the contest is more diffuse when there is no fracture. Pulmonary lasers may be caused by the same blunt or translucent force that causes bruising. Laseration may produce pulmonary hematoma; is reportedly developing in 4-11% of pulmonary contusions.
Epidemiology
Lung bruising is found in 30-75% of cases of severe chest injury, making it the most commonly occurring serious injury in association with chest trauma. Of those who had multiple injuries with an injury severity score greater than 15, bruised lung occurred about 17%. It is difficult to determine the mortality rate (death) because lung bruises rarely occur by themselves. Usually, people die with bruised lung results from other injuries, usually traumatic brain injuries. It is controversial whether a bruised lung with a missed chest is a major factor in death in itself or whether it only contributes to death in people with multiple injuries. The estimated mortality rate of lung bruising ranges from 14-40%, depending on the severity of the contusions themselves and on the associated injury. When the contusions are small, they usually do not increase the likelihood of death or poor outcome for people with blunt trauma; However, this opportunity increases with bruising size. One study found that 35% of people with some significant injuries included lung bruising died. In another study, 11% of people with lung bruises alone died, while the number rose to 22% in those with additional injuries. Lung bruises are thought to be the direct cause of death in a quarter to a half of people with many injuries (polytrauma) who die. The accompanying lute increases morbidity and mortality by more than double the lung bruise alone.
Lung bruises are the most common cause of death among passenger vehicles involved in accidents, and are thought to contribute significantly to about a quarter of deaths due to vehicle collisions. Because the use of vehicles has increased, so do the number of car accidents, and with that number of chest injuries. But an increase in the number of airbags installed in modern cars can reduce the incidence of bruising the lung. The use of a child restraint system has led to an estimated incidence of bruised lung in children in vehicle accidents from 22% to 10%.
Differences in the body of children and adults lead to different manifestations of bruised lung and related injury; for example, children have less body mass, so the same strength is more likely to cause trauma to multiple body systems. Because their chest wall is more flexible, children are more prone to bruising lung than adults, and thus suffer more generalized injuries. Lung bruising has been found in 53% of children with chest injuries requiring hospitalization. Children in strong impact suffered twice as many lung contusions as adults with similar injury mechanisms, but had fewer rib fractures. The degree to which a particular injury mechanism differs between children and adults; for example, children are more often hit by cars as pedestrians. Some differences in the physiology of children may be advantageous (eg they are less likely to have other medical conditions), and thus they have been predicted to have better results. However, regardless of this difference, children with bruised lung have the same mortality rate as adults.
History
In 1761, the Italian anatomist Giovanni Battista Morgagni first described the lung injury that was not accompanied by an injury to the chest wall above him. Nonetheless, it was the French military surgeon Guillaume Dupuytren who allegedly coined the term lung bruise in the 19th century. It was still not until the early 20th century that bruised lung and its clinical significance began to receive widespread recognition. By using explosives during World War I, many casualties were without signs beyond the chest injury but with significant bleeding in the lungs. The study of World War I injuries by D.R. Hooker pointed out that a pulmonary bruise is an essential part of a concussion injury resulting from an explosion.
Lung bruises received further attention during World War II, when bombings in the UK caused blast injuries and respiratory problems related both to soldiers and civilians. Also during this time, studies with animals placed at varying distances from the explosion indicate that protective equipment can prevent lung injury. These findings suggest that the outward impact of the chest wall is responsible for internal lesions. In 1945, the study identified a phenomenon called "wet lung", in which the lungs collect fluid and are simultaneously less able to remove it. They correlate the respiratory failure commonly seen in partial blunt trauma due to excessive fluid resuscitation, and the question of whether and how much to administer fluids has remained controversial since then.
During the Vietnam War, another battle gave an opportunity to study the bruised lung; research during this conflict plays an important role in the development of modern understanding of its treatment. This condition also began to be more widely recognized in non-combat contexts in the 1960s, and typical symptoms and findings with imaging techniques such as X-rays are described. Before the 1960s, it was believed that the respiratory insufficiency seen in chest pox was due to the "paradoxical movement" of the segment hitting the chest wall (the hit segment moved in the opposite direction to the chest wall during respiration), so the treatment was aimed at managing chest wall injuries , not a bruised lung. For example, positive pressure ventilation is used to stabilize the flay segment from within the chest. It was first proposed in 1965 that this respiratory insufficiency was most often caused by lung injury rather than to the chest wall, and the group led by J.K. Trinkle confirmed this hypothesis in 1975. Therefore modern medicine prioritizes lung bruising management. Animal studies conducted in the late 1960s and 1970s explain the pathophysiological processes involved in pulmonary bruising. Studies in the 1990s revealed a link between lung bruising and persistent respiratory difficulty for years after injury to people in whom injuries coexisted with whip breasts. In the next decade study showed that the function in the bruised lung increased over the years after the injury.
References
External links
- Chest Trauma - pulmonary bruises, trauma.org
Source of the article : Wikipedia
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