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Pulmonary Barotrauma
Aka: Pulmonary Barotrauma, Pulmonary Decompression Injury, Pulmonary Blast Injury, Blast Lung, Pulmonary Overpressurization Syndrome
- Causes
- Scuba Diving related injury (esp. breath holding)
- Blast Injury
- Pathophysiology
- Lungs are especially sensitive to Barotrauma
- Lung gas expands on ascent (Boyle's Law)
- Expanding gas without release causes lung Barotrauma
- Precautions
- Findings may be delayed up to 48 hours
- Risk Factors
- Obstructive Lung Disease (Asthma, COPD)
- Concurrent serious Blast Injury
- Skull Fracture
- Burn Injury >10% BSA
- Penetrating injury to the head or torso
- Signs
- Head and neck
- Hypopharyngeal Petechiae
- Lung findings
- Dyspnea
- Cough
- Wheezing
- Hemoptysis
- Chest Pain
- Hypoxia
- Apnea
- Decreased breath sounds
- Cardiovascular findings
- Bradycardia
- Hypotension
- Cyanosis
- Skin findings
- Subcutaneous Emphysema
- Imaging
- Chest XRay
- May demonstrate butterfly pattern (seen in Pulmonary Contusion)
- 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
- 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
- Extracorporeal Membrane Oxygenation (ECMO)
- Prognosis
- Highest mortality (11%) of all blast injuries
- 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]