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Of people with pulmonary contusion alone, 17% develop ARDS, while 78% of people with at least two additional injuries develop the condition. [6] A larger contusion is associated with an increased risk. In one study, 82% of people with 20% or more of the lung volume affected developed ARDS, while only 22% of people with less than 20% did so. [7]
The pathophysiology of acute respiratory distress syndrome involves fluid accumulation in the lungs not explained by heart failure (noncardiogenic pulmonary edema). It is typically provoked by an acute injury to the lungs that results in flooding of the lungs' microscopic air sacs responsible for the exchange of gases such as oxygen and carbon dioxide with capillaries in the lungs. [1]
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. [1] Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin coloration (cyanosis). [ 1 ]
Flail chest is usually accompanied by a pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation. [5] Often, it is the contusion, not the flail segment, that is the main cause of respiratory problems in people with both injuries. [6] Surgery to fix the fractures appears to result in better outcomes. [7]
This pulmonary-specific damage, together with the systemic inflammation, causes acute respiratory distress syndrome in about 50% of ROSC patients who survive for at least 48 hours. [12] Lung complications, such as pulmonary contusion and pulmonary edema, may result from other aspects of PCAS such as CPR and left ventricular dysfunction ...
It is often impossible to distinguish TRALI from acute respiratory distress syndrome (ARDS). The typical presentation of TRALI is the sudden development of shortness of breath, severe hypoxemia (O 2 saturation <90% in room air), low blood pressure, and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours.
After obtaining the patient's respiratory rate, the examiner looks for any signs of respiratory distress, which may include: Cyanosis, a bluish tinge of the extremities (peripheral cyanosis), or of tongue (central cyanosis) [4] Pursed-lip breathing [5] Accessory muscle use, including the scalene and intercostal muscles [5]
Typically chest injuries are caused by blunt mechanisms such as direct, indirect, compression, contusion, deceleration, or blasts [2] caused by motor vehicle collisions or penetrating mechanisms such as stabbings. [3]