II. Causes
- Scuba Diving related injury (esp. breath holding)
- Blast Injury
III. Pathophysiology
- Lungs are especially sensitive to Barotrauma
- Lung gas expands on ascent (Boyle's Law)
- Expanding gas without release causes lung Barotrauma
IV. Precautions
- Findings may be delayed up to 48 hours
V. Risk Factors
- Obstructive Lung Disease (Asthma, COPD)
- Concurrent serious Blast Injury
- Skull Fracture
- Burn Injury >10% BSA
- Penetrating injury to the head or torso
VI. Signs
- Head and neck
- Hypopharyngeal Petechiae
-
Lung findings
- Dyspnea
- Cough
- Wheezing
- Hemoptysis
- Chest Pain
- Hypoxia
- Apnea
- Decreased breath sounds
- Cardiovascular findings
- Skin findings
- Subcutaneous Emphysema
VII. Imaging
-
Chest XRay
- May demonstrate butterfly pattern (seen in Pulmonary Contusion)
VIII. Complications: Pulmonary Barotrauma
- Arterial Gas Embolism
- Pulmonary Contusion (most common Pulmonary Blast Injury, presentation may be delayed 48 hours)
- Pneumothorax
- Pneumomediastinum
- Interstitial Emphysema
- Mediastinal Emphysema
- Subcutaneous Emphysema
IX. Management
-
Endotracheal Intubation indications
- Massive heomptysis
- Impending airway compromise
- Respiratory Failure
- Management similar to Pulmonary Contusion
- Adequate fluid Resuscitation but avoid Fluid Overload
- Prevent Hypoxemia with High Flow Oxygen
- Avoid excessive Positive Pressure Ventilation
- Risks pulmonary alveolar rupture and Arterial Gas Embolism
- Limit peak inspiratory pressures to <40 cm H2O
- Manage Pneumothorax or Hemothorax
- Prompt Chest Tube placement for decompression
- Severe case options
X. Prognosis
- Highest mortality (11%) of all blast injuries
XI. References
- (2016) CALS Manual, 14th edition 1: 42-3
- Jagminas (2015) Crit Dec Emerg Med 29(5): 2-11
- Mackenzie (2011) Philos Trans R Soc Lond B Biol Sci 366(1562): 295–299 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 123672002 |
| English | Pulmonary barotrauma, Pulmonary volume trauma, Pulmonary barotrauma (disorder) |
| Spanish | barotrauma pulmonar (trastorno), barotrauma pulmonar |
Ontology: Pulmonary decompression injury (C0344192)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 241997003 |
| 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 |
| SnomedCT | 242006000 |
| 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 |
