chest trauma pt 2

Pulmonary Contusion Mechanism

Fluid Leakage and Gas Exchange Deficits.

Pulmonary Contusion

Rapid compression and decompression of the chest wall tears the delicate pulmonary capillary network, triggering serum protein leakage and intra-alveolar hemorrhage.

Osmotic Pressure Fluid Shift

Extravasated proteins draw system fluids into interstitial spaces, worsening alveolar edema.

Excellent Culture Medium

Accumulating blood and interstitial fluids create a highly fertile environment for progressive segment pneumonia.

ARDS-like Progression

Severe cases mirror ARDS, producing frothy, bloody secretions, cyanosis, and profound acidosis.

Severe Pulmonary Contusion Mortality

50% Mortality in Severe Cases (often develops slowly over 24-48 hours post-injury, masking initial severity.)

Classification of Pneumothorax

Simple, Open (Sucking), and Tension.

Simple Pneumothorax

Air enters the negative-pressure pleural space via a visceral or parietal breach, commonly from a ruptured subpleural bleb or fistula.

Open (Sucking) Pneumothorax

A large chest wall defect allows air to rush freely in and out. This creates a severe mediastinal swing (flutter) that impairs system circulation.

Tension Pneumothorax

Laceration creates a one-way valve: air enters on inspiration but cannot escape. Exploding intrathoracic pressure shifts the mediastinum.

Tension Relief and Tamponade

Emergency Thoracic Decompression.

Emergency Thoracic Decompression

To prevent pulseless electrical activity (PEA), tension pneumothorax must be converted immediately to a simple pneumothorax.

Tension Pneumothorax Decompression

Decompress with a 14G needle at the 5th intercostal space midaxillary line.

Pericardial Tamponade

Pericardial fluid/blood blocks diastolic filling, triggering rapid circulatory shock.

Treatment of Pericardial Tamponade

Urgently treat with pericardiocentesis.