Overview
The explosion produced high-pressure wave (air or water waves) on the chest impact caused by lung injury, often characterized by external light internal heavy, the patient’s symptoms are very serious, while the external surface of the chest is not obvious damage, the main manifestations are: dyspnea, hemoptysis foamy sputum, respiratory failure in severe cases.
etiology
explosion generated high-pressure waves (air or water waves) on the chest impact caused by lung injury.
symptoms
The clinical manifestations of lung concussion injury varies according to the severity of the injury. Light cases only have a short period of chest pain, chest tightness or breathlessness. Slightly severe cases of coughing, hemoptysis or bloody sputum within 1 to 3 days after the injury, a small number of dyspnea, auscultation can be heard variable scattered wet rales or twisted sound. In severe cases, obvious dyspnea, cyanosis, bloody foamy sputum, etc., often accompanied by shock. In addition to pulmonary rales, there may be signs of pulmonary solid changes and hemopneumothorax. In addition, it is often accompanied by other organ injuries.X-ray examination shows thickening of lung texture, patchy shadows, reduced transmittance, or even large flaky dense shadows, and there may be pulmonary atelectasis and hemopneumothorax. Blood gas examination may show abnormal results of varying severity.
Examination
1. X-ray examination
Thickening of the lung texture, patchy shadows, reduced transmittance, or even large dense shadows can be seen in the lungs, and there may be pulmonary atelectasis and hemopneumothorax.
2. Blood gas examination
Abnormal results of varying degrees of severity may occur. Generally, there is persistent hypoxemia.
3. Physical examination
In addition to pulmonary rales, there may be signs of pulmonary solid changes and hemopneumothorax.
4. Chest CT examination
If it shows a cloudy shadow with increased density, it suggests alveolar and interstitial hemorrhage.
Diagnosis
Based on the history and clinical manifestations, it is not difficult to make a diagnosis by combining with the corresponding examination.
Treatment
The treatment of pulmonary blast injury is to maintain respiratory and circulatory functions, including keeping the airway open, administering oxygen, tracheotomy and artificial respirator to assist breathing if necessary, and blood transfusion and fluid replacement to resist shock. If there is hemopneumothorax, make chest closed drainage as soon as possible. Give hemostatic drugs. Apply sufficient amount of antibiotics to prevent infection. For the combination of other organ injuries for the corresponding treatment.
Once the lung concussion injury constitutes a serious compound injury, the body will produce a strong stress reaction, which will easily lead to stress reaction disorder, the occurrence of digestive stress ulcers, intestinal infections, high metabolism, etc., which will cause serious pathologic damage to the organs of the whole body, making the patient’s condition complex and changeable, and the treatment is difficult. Therefore, in the treatment process of pulmonary blast injury compound severe burns, according to the classification of the severity of the injury, personalized treatment, tracheotomy is performed immediately after a clear diagnosis, artificial air is established, and the airway is kept open. When sputum crusts are suspected of obstructing the airway, fiberoptic bronchoscopy should be carried out immediately to remove the sputum crusts and make irrigation. Electrocoagulation is given to stop bleeding in the respiratory tract, and patients whose dyspnea does not improve and hypoxemia persists should be assisted with respiration by respiratory assistance using high-frequency or end-of-breath positive-pressure ventilation, so as to maximize the effect of ultrasonic nebulized inhalation to humidify the airway, promote the discharge of sputum, remove the stimulation of foreign bodies, and reduce the role of various inflammatory mediators. The use of ventilator should follow the principle of “early machine, early withdrawal, personalized”. When the patient’s spontaneous respiration recovery is good, the cough is strong, the monitoring blood gas analysis is normal and stable, you can consider taking off the machine, and should strive to take off the machine as soon as possible, to avoid ventilator dependence.
Prevention
The prevention of this disease is mainly to actively prevent the occurrence of various complications. For example, for patients with burns, actively control the infection to prevent the occurrence of lung infection. For patients who need to be on lung ventilator, the principle of “morning machine, early withdrawal, personalized” should be followed. And should strive for the early release of the machine, to avoid ventilator dependence. For patients suspected to be at risk of respiratory obstruction, tracheotomy can be performed earlier.