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Discussion

Blunt Chest Trauma

Thoracic trauma accounts for 25% of all trauma fatalities. Blunt trauma mortality is high because it is often associated with multi-system injuries.

Types of pulmonary injuries include pulmonary contusion,
pneumothorax, hemothorax, and pneumomediastinum.

 

Chest wall injuries may also occur with blunt chest trauma. These injuries include rib fractures, flail chest,

 

tracheobronchial disruption and diaphragmatic rupture. Most cardiac injury due to blunt chest trauma involves compression of the vertebral column. The right ventricle is the most frequently injured chamber due to its position. Life-threatening emergencies following blunt chest trauma require accurate assessments and rapid interventions to prevent unnecessary complications and death. The major objective in the initial management of these patients is to restore normal cardiopulmonary function. This is accomplished by establishing an adequate airway and ventilation, and correction of hypovolemia or low cardiac output.

Differential Lung Ventilation

Differential lung ventilation (DLV) requires a double-lumen endotracheal tube and two ventilators set to cycle in sync. One ventilator acts as the primary ventilator and the other as the secondary ventilator. DLV is usually begun by applying equal tidal volumes to each lung while monitoring airway pressures. If airway pressures are too high, the tidal volume in the less compliant lung is adjusted downward while shifting volume to the other lung in an attempt to avoid barotrauma. PEEP is then applied in inversely proportional amounts to lung compliance to equalize the functional residual capacity of each lung.

References
    1. Rankin N, Day AC, Crone PD. Traumatic massive air leak treated with prolonged double lumen intubation and high frequency ventilation: case report. The Journal of Trauma 1994; 36(3): 428- 429.
    2. Carrero R, Wayne M. Chest trauma. Emerg Med Clin North Am 1989; 7(2): 389-418.
    3. Barber J, Atkins P. Clinical manifestations of blunt cardiac injury: a challenge to critical care practitioner. Crit Care Nurse Q 1994; 7(2): 13-23.
    4. Prentice D, Ahrens T. Pulmonary Complications of trauma. Crit Care Nurse Q 1994; 17(2): 24-33.
    5. Strange C. Double-lumen endotracheal tubes. Clinics in Chest Medicine 1991; 12(3): 497-505.
    6. London PS. Color Atlas of Diagnosis After Recent Injury. St. Louis: Mosby-Year Book, Inc., Co., 1990; 37-38.
    7. McMurtry RY, McLellan BA. Management of Blunt Trauma. Baltimore: Williams and Wilkins, Co. 1990; 165-184.
    8. Hood RM. Surgical Diseases of the Pleura and Chest Wall. Philadelphia: WB Saunders Co. 1986; 222.