Management of Blunt Pulmonary Injury

2014 ◽  
Vol 25 (4) ◽  
pp. 375-386 ◽  
Author(s):  
John J. Gallagher
Keyword(s):  
Lung Parenchyma ◽  
Tracheobronchial Tree ◽  
Pleural Space ◽  
Pulmonary Contusion ◽  
Initial Assessment ◽  
Thoracic Injuries ◽  
Airway Control ◽  
Tracheobronchial Injuries ◽  
Ventilation Strategies ◽  
And Control

Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.

Pentoxifylline and Oxypurinol: Potential Drugs to Prevent the “Cytokine Release (Storm) Syndrome” Caused by SARS-CoV-2?

2020 ◽  
Vol 26 (35) ◽  
pp. 4515-4521
Author(s):  
Francisco J. López-Iranzo ◽  
Ana M. López-Rodas ◽  
Luis Franco ◽  
Gerardo López-Rodas
Keyword(s):  
Lung Parenchyma ◽  
Interstitial Tissue ◽  
Cytokine Release ◽  
Phase I Clinical Trials ◽  
Infected People ◽  
Tnf Α ◽  
Transient Loss ◽  
Anti Inflammatory ◽  
And Control ◽  
Inflammatory Action

Background: COVID-19, caused by SARS-CoV-2, is a potentially lethal, rapidly-expanding pandemic and many efforts are being carried out worldwide to understand and control the disease. COVID-19 patients may display a cytokine release syndrome, which causes severe lung inflammation, leading, in many instances, to death. Objective: This paper is intended to explore the possibilities of controlling the COVID-19-associated hyperinflammation by using licensed drugs with anti-inflammatory effects. Hypothesis: We have previously described that pentoxifylline alone, or in combination with oxypurinol, reduces the systemic inflammation caused by experimentally-induced pancreatitis in rats. Pentoxifylline is an inhibitor of TNF-α production and oxypurinol inhibits xanthine oxidase. TNF-α, in turn, activates other inflammatory genes such as Nos2, Icam or IL-6, which regulate migration and infiltration of neutrophils into the pulmonary interstitial tissue, causing injury to the lung parenchyma. In acute pancreatitis, the anti-inflammatory action of pentoxifylline seems to be mediated by the prevention of the rapid and presumably transient loss of PP2A activity. This may also occur in the hyperinflammatory -cytokine releasing phase- of SARS-CoV-2 infection. Therefore, it may be hypothesized that early treatment of COVID-19 patients with pentoxifylline, alone or in combination with oxypurinol, would prevent the potentially lethal acute respiratory distress syndrome. Conclusion: Pentoxifylline and oxypurinol are licensed drugs used for diseases other than COVID-19 and, therefore, phase I clinical trials would not be necessary for the administration to SARS-CoV-2- infected people. It would be worth investigating their potential effects against the hyperinflammatory response to SARS-CoV-2 infection.

scholarly journals Radiation diagnostics of thoracic gunshot wounds

2020 ◽  
pp. 70-80
Author(s):  
Iryna Dykan
Keyword(s):  
Soft Tissues ◽  
General Structure ◽  
Ground Glass Opacity ◽  
Gunshot Wounds ◽  
Lung Parenchyma ◽  
Combat Trauma ◽  
Side Impact ◽  
Pulmonary Contusion ◽  
Projectile Energy ◽  
Surgical Trauma

The frequency of thoracic injuries in the general structure of combat surgical trauma remains at the level of 7-12 % and unchanged from the time of the Second World War to the current armed conflicts. The overwhelming majority of them (up to 72 %) are shrapnel gunshot wounds. The formation of a gunshot wound occurs due to the action of a shock wave; a wounding projectile; energy of side impact and vortex wake. The shape, size, features of the wound canal are determined by the kinetic energy of the wounding agent and the physical properties of the damaged tissues. The lung parenchyma is loose and elastic, so small-caliber bullets with low energy cause minimal damage. The wound canal is well differentiated on CT-slices. Its cavity is filled with blood, fragments of destroyed tissue, air bubbles. On the periphery, the contusion zone is determined (area of increased attenuation in the lung-ground-glass opacity). Shrapnel wounds can be accompanied by ruptures of the pulmonary parenchyma with hemorrhages, bilateral pulmonary contusion, damage to the bone frame and soft tissues of the chest. Vascular injury with massive hemorrhage into the pleural cavity and tense hemopneumothorax are one of the main causes of mortality in penetrating wounds. Transmediastinal gunshot wounds, armor trauma and bullet embolism require special attention during radiation examination of victims. The purpose of radiation diagnostics of modern combat trauma is to identify and fully characterize injuries and their complications. The amount of diagnostic information is determined by the level of medical care. Key words: gunshot wounds, chest cavity organs, radiation diagnostics.

Role of diagnostic imaging in diagnosis by Covid-19

2020 ◽  
Author(s):  
Coda Marco ◽  
Sica Federica ◽  
Finelli Mirko ◽  
Ungaro Gaetano ◽  
Sica Alfonso Marco
Keyword(s):  
Differential Diagnosis ◽  
Lung Parenchyma ◽  
Chest Ct ◽  
Initial Assessment ◽  
X Rays ◽  
Radiological Imaging ◽  
Laboratory Examinations ◽  
Clinical Conditions

The diagnosis from Covid-19 provides the set of several examinations such as: clinical examinations, laboratory examinations, radiographic examinations. Using radiological imaging, RX and chest CT, it is possible to evaluate the impairment of lung function and thanks to this aspect it is possible to define the severity and clinical conditions of the patient. In this way, it allows timely therapeutic intervention especially if the patient shows a mild condition in such a way as to avoid the onset of further complications. Chest X-rays allow both an initial assessment of patients and the possibility to perform a differential diagnosis towards other possible causes of lung parenchyma involvement. The CT scan, which highlights the peculiar characteristics of COVID pneumonia, is performed both as diagnostic confirmation and in the patient’s follow-up.

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

scholarly journals Surgical Tension Pneumothorax during Laparoscopic Repair of Massive Hiatus Hernia: A Different Situation Requiring Different Management

2011 ◽  
Vol 39 (6) ◽  
pp. 1120-1123 ◽  
Author(s):  
S. Phillips ◽  
G. L. Falk
Keyword(s):  
Carbon Dioxide ◽  
Hiatus Hernia ◽  
Laparoscopic Repair ◽  
Open Surgery ◽  
Tension Pneumothorax ◽  
Lung Parenchyma ◽  
Pleural Space ◽  
Parietal Pleura ◽  
High Solubility ◽  
Lung Trauma

During laparoscopic repair of massive hiatus hernia, surgical dissection can breach the parietal pleura allowing insufflating carbon dioxide to rapidly expand the pleural space, causing a tension pneumothorax. This extrapulmonary pneumothorax involves no damage to the lung parenchyma. Its rapid resolution is aided by the high solubility of carbon dioxide and it will not refill once the procedure is completed. In this series of 50 massive hiatus hernia repairs the incidence of pneumothorax was 22% (11/50), with two of these being bilateral. Cardiovascular compromise occurred in 91% of those (10/11). The aetiology, pathophysiology and management of this intraoperative capnothorax differ significantly from that of a pneumothorax secondary to lung trauma or occurring during other types of laparoscopy. Understanding the relevant pleural anatomy and pathophysiology of this condition allowed conservative management in all cases and avoided the need for chest drains, open surgery or abandonment of the procedure.

Multiple cervical bronchogenic cysts

2006 ◽  
Vol 120 (2) ◽  
pp. 145-147 ◽  
Author(s):  
Kyaw Htin Maung ◽  
Christopher Low ◽  
Lindsey C Knight ◽  
Catherine J Cullinane
Keyword(s):  
Lung Parenchyma ◽  
Tracheobronchial Tree ◽  
Respiratory Obstruction ◽  
Congenital Lesions ◽  
Upper Respiratory ◽  
Hoarse Voice ◽  
Bronchogenic Cysts

Bronchogenic cysts are rare, benign, congenital lesions that occur as a result of aberrant development of the tracheobronchial tree during embryogenesis. They usually present during the first decade of life and are encountered predominantly within the mediastinum or the lung parenchyma. In a few instances, they appear within the neck mimicking a neoplasm and, depending on their size and site, may also cause acute upper respiratory obstruction. We describe a case of two cervical bronchogenic cysts adjacent to the larynx in a child who presented with a hoarse voice.

INSURER PERCEPTION OF ENVIRONMENTAL MANAGEMENT SYSTEMS REGARDING INSURANCE FOR POLLUTION

2002 ◽  
Vol 04 (03) ◽  
pp. 349-366 ◽  
Author(s):  
D. M. MINOLI ◽  
J. N. B. BELL
Keyword(s):  
Environmental Management ◽  
Point Of View ◽  
Management Systems ◽  
Initial Assessment ◽  
Environmental Management Systems ◽  
Political Issues ◽  
The Uk ◽  
And Control

This paper explores the use of insurance and environmental management systems (EMSs) to prevent and control the risk of pollution. To assess this issue, a series of interviews with insurers was conducted to find out their opinions and attitudes on EMSs about insurance for pollution. The main scope of the research is composite insurance, public liability and EMSs, within the UK market. Insurers' believed that EMSs could theoretically help insureds and insurers, respectively, prevent and control, and assess and settle pollution. However, there is little evidence to support this assertion. Moreover, EMSs assess pollution incompletely from the insurers' point of view. Furthermore, insurers' initial assessment and post loss investigation of pollution are generally not well developed, and there is little knowledge about and poor recognition of EMSs. Economic, practical, legal and political issues hinder insurers' ability to respond positively to EMSs. Therefore, insurance and EMSs are insufficiently developed to play a lead role in lessening the risk of pollution.

Influence of Lung Aeration on Pulmonary Concentrations of Nebulized and Intravenous Amikacin in Ventilated Piglets with Severe Bronchopneumonia

2002 ◽  
Vol 97 (1) ◽  
pp. 199-206 ◽  
Author(s):  
Marilia Elman ◽  
Ivan Goldstein ◽  
Charles-Hugo Marquette ◽  
Fréderic Wallet ◽  
Gilles Lenaour ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Mechanical Ventilation ◽  
Intravenous Administration ◽  
Porcine Model ◽  
Lung Parenchyma ◽  
Tracheobronchial Tree ◽  
Lung Deposition ◽  
Equivalent Dose ◽  
Intravenous Injections ◽  
Lung Aeration

Background Pulmonary concentrations of aminoglycosides administered intravenously are usually low in the infected lung parenchyma. Nebulization represents an alternative to increase pulmonary concentrations, although the obstruction of bronchioles by purulent plugs may impair lung deposition by decreasing lung aeration. Methods An experimental bronchopneumonia was induced in anesthetized piglets by inoculating lower lobes with a suspension of 10(6) cfu/ml Escherichia coli. After 24 h of mechanical ventilation, 7 animals received two intravenous injections of 15 mg/kg amikacin, and 11 animals received two nebulizations of 40 mg/kg amikacin at 24-h intervals. One hour following the second administration, animals were killed, and multiple lung specimens were sampled for assessing amikacin pulmonary concentrations and quantifying lung aeration on histologic sections. Results Thirty-eight percent of the nebulized amikacin (15 mg/kg) reached the tracheobronchial tree. Amikacin pulmonary concentrations were always higher after nebulization than after intravenous administration, decreased with the extension of parenchymal infection, and were significantly influenced by lung aeration: 197 +/- 165 versus 6 +/- 5 microg/g in lung segments with focal bronchopneumonia (P = 0.03), 40 +/- 62 versus 5 +/- 3 microg/g in lung segments with confluent bronchopneumonia (P = 0.001), 18 +/- 7 versus 7 +/- 4 microg/g in lung segments with lung aeration of 30% or less, and 65 +/- 9 versus 2 +/- 3 microg/g in lung segments with lung aeration of 50% or more. Conclusions In a porcine model of severe bronchopneumonia, the nebulization of amikacin provided 3-30 times higher pulmonary concentrations than the intravenous administration of an equivalent dose. The greater the lung aeration, the higher were the amikacin pulmonary concentrations found in the infected lung segments.

Aspiration Pneumonitis: A Review and Experiment on Tracheobronchial Lavage

1974 ◽  
Vol 83 (6) ◽  
pp. 795-801 ◽  
Author(s):  
Michael E. Sudderth
Keyword(s):  
Tracheobronchial Tree ◽  
Fluid Replacement ◽  
Positive Pressure ◽  
Lung Weight ◽  
Acid Aspiration ◽  
Airway Control ◽  
Oxygen Administration ◽  
Pressure Oxygen ◽  
Acid Aspiration Syndrome

The gastric acid aspiration syndrome was first described by Mendelson in 1945. The usual clinical features of cyanosis, tachycardia, hypotension and dyspnea are produced when liquid vomitus of less than 2.5 pH is inhaled into the tracheobronchial tree. Treatment usually includes airway control, positive pressure oxygen administration, fluid replacement, steroids and antibiotics. The role of bronchoscopy and tracheobronchial lavage in treatment has never been clearly defined. Sixty dogs were studied using bronchoscopy and normal saline lavage following hydrochloric acid aspiration. Using the parameters of survival, blood gas values, lung weight and pathology, no benefit was demonstrated. Bronchoscopy and lavage are not recommended unless solid particle aspiration occurs.

scholarly journals A prospective study of chest injuries and associated complications with special reference to surgical emphysema

2018 ◽  
Vol 5 (3) ◽  
pp. 873
Author(s):  
Sunil Kumar Dangi ◽  
Naresh Meena ◽  
Ashok Parmar
Keyword(s):  
Thoracic Trauma ◽  
Road Traffic ◽  
Bone Fractures ◽  
Flail Chest ◽  
Pulmonary Contusion ◽  
Long Bone ◽  
Trauma Patients ◽  
Thoracic Injuries ◽  
Female Ratio ◽  
Surgical Emphysema

Background: Chest trauma (or thoracic trauma) is a serious injury of the chest. Thoracic injuries may present extremely dramatic clinical problem that demand rapid diagnosis, decision making and aggressive management. Thoracic injuries can range from simple single rib fracture to major thoracic vessel injury and pulmonary contusion.Objective of this study was to describe the clinical characteristics and risk factors of thoracic trauma patients, and to evaluate their relationship in the development of complications with special emphasis to surgical emphysema.Methods: Descriptive, prospective and analytical study of a cohort of patients with thoracic trauma who were followed up for a period of 30 days. Excluded from the study were those patients with moderate to severe cranio-encephalic trauma, long bone fractures, abdominal trauma, and patients who required mechanical ventilation.Results: A total of 102 patients met the inclusion criteria out of which 90(88.23%)patients were male and 12(11.77%) female with male to female ratio of 7.5:1. Patients having surgical emphysema were all male 21(21.56%). Most common mode of the injury seen was road traffic accidents in 80 (80.95%) patients, followed by assault in 9(9.52%) patients, bull horn injury and fall from height in 4(4.76%) patients. Other chest injury which was most commonly associated with surgical emphysema was haemothorax in 11(52.38%) patients, followed by pneumothorax in 7(33.33%) patients, pulmonary contusion in 6(28.57%) patients and flail chest in 3(14.26%) patients. The risk of complications increases significantly in patients with more than 2 rib fractures, in older patients and in the presence of some comorbidities such as COPD and pathologies that require anticoagulation. The risk of re-admittance is greater in patients older than 60 years.Conclusions: Patients with thoracic trauma who present with co-morbidities, are older than 60 years and have more than 2 ribs fractures may present with more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.

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