Emergency medicine clinics of North America
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Pulmonary parenchymal damage is a frequent consequence of major trauma to the chest. Among the injuries considered in this article are traumatic pulmonary pseudocysts, pulmonary hematomas, major pulmonary lacerations, pulmonary contusions, and penetrating pulmonary parenchymal injuries. Also discussed is emergency resuscitation of patients with pulmonary parenchymal injuries.
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The clinical presentations of chest wall and diaphragmatic disorders are extremely diverse, and the attention of the emergency physician is often directed to a more obvious problem. The common denominator of these disorders is their effect on respiratory mechanics, a discussion of which precedes the review of specific disorders.
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Patients with significant respiratory disease are evaluated daily by emergency physicians. Understanding the principles of respiratory physiology and pathophysiology provides the basis for the diagnosis and management of patients with respiratory disease.
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The interrelationships of several important factors contribute to the development of pulmonary edema. These factors include hydrostatic and osmotic forces, capillary membrane permeability, and lymphatic drainage capacity. Whether the pulmonary edema is cardiogenic or noncardiogenic, optimal management is facilitated by the improvement of ventilation and gas exchange within the lungs and the restoration of oxygen transport to peripheral tissues. The keystones in such therapy include the administration of oxygen, diuretics, and vasodilators; the use of mechanical ventilation; and the implementation of specific therapy directed toward underlying disorders.
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Emerg. Med. Clin. North Am. · Aug 1983
ReviewPneumothorax, hemothorax, and other abnormalities of the pleural space.
The clinical setting and treatment of various types of pneumothorax are detailed; chylothorax and hemothorax are also discussed. Tube thoracostomy, which can be performed with basic surgical skills if attention is paid to potential complications and optimal technique, is described.