The Surgical clinics of North America
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Surg. Clin. North Am. · Feb 1989
Pulmonary contusion. Evaluation and classification by computed tomography.
In thoracic trauma, as in all of medicine, diagnosis precedes therapy. Over the past 5 years, we have liberally used chest CT examinations to improve diagnosis in the severely injured patient. ⋯ Confidence in our method of quantitation has helped us to assess the severity of pulmonary parenchymal injuries. Correlation of the CT findings with histologic study has changed our concept of pulmonary contusion from that of interstitial disease to that of pulmonary laceration with blood pneumonia.
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Surg. Clin. North Am. · Feb 1989
ReviewAcute post-traumatic respiratory physiology and insufficiency.
This article reviews the physiologic mechanisms by which acute injury results in respiratory insufficiency. It delineates the need for oxygenation versus ventilatory support and provides a pragmatic approach to dealing with the proper early respiratory support of the victim of chest trauma as well as the rationale for various immediate treatment modalities. In addition, it discusses various assessment techniques and clinical clues that predict the onset of late respiratory complications in the patient with serious injuries.
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Chest wall injuries range from relatively trivial to fatal flail chest or huge defects. Significant chest wall injury is present in about one third of patients admitted after severe trauma. In management, the principal areas to be considered are pain control, open wounds, pneumothorax, flail chest, and pulmonary contusion.
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Technologic aid is available for the three central problems of hemorrhage, lung damage, and cardiac damage. Autotransfusion, new modes of ventilator support, extracorporeal oxygenation, balloon pumping, and left ventricular assist are available for the trauma patient. The author explains these new devices and their role in thoracic trauma cases.