II. Causes

  1. Scuba Diving related injury (esp. breath holding)
  2. Blast Injury

III. Pathophysiology

  1. Lungs are especially sensitive to Barotrauma
  2. Lung gas expands on ascent (Boyle's Law)
  3. Expanding gas without release causes lung Barotrauma

IV. Precautions

  1. Findings may be delayed up to 48 hours

V. Risk Factors

  1. Obstructive Lung Disease (Asthma, COPD)
  2. Concurrent serious Blast Injury
    1. Skull Fracture
    2. Burn Injury >10% BSA
    3. Penetrating injury to the head or torso

VI. Signs

  1. Head and neck
    1. Hypopharyngeal Petechiae
  2. Lung findings
    1. Dyspnea
    2. Cough
    3. Wheezing
    4. Hemoptysis
    5. Chest Pain
    6. Hypoxia
    7. Apnea
    8. Decreased breath sounds
  3. Cardiovascular findings
    1. Bradycardia
    2. Hypotension
    3. Cyanosis
  4. Skin findings
    1. Subcutaneous Emphysema

VII. Imaging

  1. Chest XRay
    1. May demonstrate butterfly pattern (seen in Pulmonary Contusion)

VIII. Complications: Pulmonary Barotrauma

  1. Arterial Gas Embolism
  2. Pulmonary Contusion (most common Pulmonary Blast Injury, presentation may be delayed 48 hours)
  3. Pneumothorax
  4. Pneumomediastinum
  5. Interstitial Emphysema
  6. Mediastinal Emphysema
  7. Subcutaneous Emphysema

IX. Management

  1. Endotracheal Intubation indications
    1. Massive heomptysis
    2. Impending airway compromise
    3. Respiratory Failure
  2. Management similar to Pulmonary Contusion
    1. Adequate fluid Resuscitation but avoid Fluid Overload
    2. Prevent Hypoxemia with High Flow Oxygen
  3. Avoid excessive Positive Pressure Ventilation
    1. Risks pulmonary alveolar rupture and Arterial Gas Embolism
    2. Limit peak inspiratory pressures to <40 cm H2O
  4. Manage Pneumothorax or Hemothorax
    1. Prompt Chest Tube placement for decompression
  5. Severe case options
    1. Extracorporeal Membrane Oxygenation (ECMO)

X. Prognosis

  1. Highest mortality (11%) of all blast injuries

XI. References

  1. (2016) CALS Manual, 14th edition 1: 42-3
  2. Jagminas (2015) Crit Dec Emerg Med 29(5): 2-11
  3. Mackenzie (2011) Philos Trans R Soc Lond B Biol Sci 366(1562): 295–299 [PubMed]

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Related Studies

Ontology: Pulmonary barotrauma (C0034055)

Concepts Injury or Poisoning (T037)
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Spanish barotrauma pulmonar (trastorno), barotrauma pulmonar

Ontology: Pulmonary decompression injury (C0344192)

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English Pulmonary decompression injury, The chokes, Pulmonary decompression injury (disorder)
Spanish lesión pulmonar por descompresión (trastorno), lesión pulmonar por descompresión

Ontology: Blast lung (C0349512)

Concepts Injury or Poisoning (T037)
ICD10 S27.31
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English Blast injury of lung NOS, blast injury lung, blast lung, Blast injury to lungs, Blast lung, Blast lung (disorder)
Spanish lesión pulmonar por explosión (trastorno), lesión pulmonar por explosión

Ontology: Pulmonary overpressurization syndrome (C0413278)

Concepts Injury or Poisoning (T037)
SnomedCT 242000006
English Pulmonry overpressuristn syndr, Burst lung, Pulmonary overpressurisation syndrome, Pulmonary overpressurization syndrome (disorder), Pulmonary overpressurization syndrome
Spanish síndrome de presurización pulmonar excesiva (trastorno), síndrome de presurización pulmonar excesiva