Pulmonary barotrauma

Introduction Lung pressure injury refers to the alveolar pressure in the alveolar damage, the gas leaks into the alveolar tissue, and the lung communicates with the outside through the trachea, larynx and nasopharyngeal cavity. Only the vocal cords can be switched on this channel. If the vocal cords are closed during pressurization, the external pressure will be greater than the pressure in the trachea and lungs. Because the chest wall is very strong, the pressure bearing capacity is very large, so it will not cause air pressure loss.

Cause

Due to the poor pressure bearing capacity of the lung tissue, when the pressure difference between the inside and outside of the lung is greater than 10.6 kPa (80 mmHg), the lung tissue will over-expand, causing the alveolar wall, blood vessels, interstitial tearing to cause pneumothorax, mediastinal emphysema, subcutaneous gas. Swell, if the gas enters the ruptured blood vessels, it will cause gas embolism. Pneumatic injury in the lungs is only seen in divers, sinkers, and patients undergoing hyperbaric oxygen therapy. During the decompression process, inappropriate breath holding, coughing, convulsions (epileptic seizures, brain-type oxygen poisoning) cause the vocal cords to close, resulting in trachea and The pressure in the lungs is dry and the external pressure.

an examination

Related inspection

Lung imaging pulmonary ventilation biopsy

Common clinical manifestations are: pulmonary interstitial emphysema, pulmonary mediastinal emphysema, pneumothorax, subcutaneous emphysema, arteriovenous thrombosis, pleural bronchospasm and so on.

First, X-ray examination: thoracic expansion, rib clearance widened, ribs parallel, activity weakened, sputum reduced and flattened, the transparency of the two lung fields increased.

Second, ECG examination: generally no abnormalities, sometimes can be low voltage.

Third, respiratory function check: It is important to diagnose obstructive emphysema.

Fourth, blood gas analysis: If there is obvious hypoxic carbon dioxide retention, the arterial partial pressure of oxygen (PaO2) decreases, the partial pressure of carbon dioxide (PaCO2) increases, and decompensated respiratory acidosis can occur, and the pH value decreases. .

Fifth, blood and sputum examination: generally no abnormalities, secondary infections like acute episodes of acute episodes.

Differential diagnosis

Differential diagnosis of pulmonary barotrauma:

Sub-pulmonary compensatory emphysema: Compensatory emphysema is a normal physiological process, because the total area of the lungs after the removal of the lungs is reduced, in order to ensure the body's oxygen needs, the other side of the lungs will Modern compensatory expansion, resulting in compensatory emphysema, general compensatory emphysema is asymptomatic, but if the lung loses this function, it belongs to non-compensatory emphysema.

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