Purulent diseases of lungs and pleura

1. Pulmonary Trauma. Purulent
diseases of lungs and pleura

2. lungs anatomy

3. lungs anatomy

4. lungs anatomy

5. lungs anatomy

6. Phisiology

7. Chest wall Injuries
• Contusion
• Haematomas
• Rib fracture
• Sternal fracture

17. Prolonged traction

19. Treatment
Rest
Oxygen (if need)
Analgetics (narcotic and non narcotic analgesic)
Block anesthesia (Lingocaine )
Cough-depressant drugs
Codeine 10-20 mg 4 times a day
Aethylmorphini hydrochloridum 10-30 mg 2-3 times a day
Dextromethorphan 15 mg 4-6 times a day
Troxevasin ointment (local)
Drainage of haematomas (if need)

20. Pulmonary injury
• Pulmonary contusion
• Pulmonary laceration
Pneumothorax
Hemothorax
Hemopneumothorax

21. Pulmonary contusion
• Chest pain
• Trouble breathing
• Coughing up blood or large amounts of watery
sputum (spit)
• Fast and shallow breathing
• High-pitched wheezing when patient breathe
out
• Lung sounds: hypophonesis

22. Pulmonary contusion

23. Pulmonary contusion

24. Treatment
Rest
Oxygen (if need)
Artificial lung ventilation (ALV) if need
Narcotic analgesic ???
Euphyuinum 2,4% 10ml IV
Haemostatics
Block anesthesia (Lingocaine 0,2-0,5%)
Cough-depressant drugs ???
Codeine 10-20 mg 4 times a day
Aethylmorphini hydrochloridum 10-30 mg 2-3 times a day
Dextromethorphan 15 mg 4-6 times a day
Therapeutic bronchoscopy
Antibiotics
Thoracotomy

25. Pulmonary laceration
• Abnormal breathing movement
• Restricting chest wall motion when breathing to
protect against pain
• Splinting -- bending over or holding the chest to
protect against pain
• Cough
• Rapid respiratory rate
• Shortness of breath
• Sudden chest pain or chest tightness
• Breathing or coughing makes pain worse
• Chest pain may be dull, sharp, or stabbing

26. Closed pneumothorax
• Tachypnea
• Tachycardia
• Respiratory distress
• Absent or decreased breath sounds on the
affected side
• Hyperresonance
• Decreased chest wall movement
• Dyspnea
• Chest pain referred to the shoulder or arm on the
affected side
• Slight pleuritic chest pain

27. Closed pneumothorax

28. Treatment
• Needle thoracostomy 2 intercostal space
along the medioclavicular line
• Tube thoracostomy

29. Needle thoracostomy

31. Open Pneumothorax

32. subcutaneous emphysema

33. Treatment
• occlusive dressing

34. Tube thoracostomy

35. Tension Pneumothorax

36. Treatment
• occlusive dressing
• Needle thoracostomy 2 intercostal space
along the medioclavicular line
• Tube thoracostomy
• Thoracotomy

37. Hemothorax

38. Treatment
• Tube thoracostomy
• Thoracotomy

39. Thoracotomy (frontside)

40. Thoracotomy (backside)

41. Diaphragmatic injury
• Rupture can allow intra-abdominal organs to
enter the thoracic cavity, which may cause the
following:
– Compression of the lung with reduced ventilation
– Decreased venous return
– Decreased cardiac output
– Shock

42. Diaphragmatic injury
• Tachypnea
• Tachycardia
• Respiratory distress
• Dullness to percussion
• Scaphoid abdomen (hollow or empty appearance)
– If a large quantity of the abdominal contents are displaced into the
chest
• Bowel sounds in the affected hemithorax
• Decreased breath sounds on the affected side
• Possible chest or abdominal pain

43. Diaphragmatic injury

44. Diaphragmatic injury

45. Diaphragmatic injury
• Treatment
restore integrity

46. Purulent diseases of lungs and pleura
• Empyema
• Lung Abscess

47. Empyema of pleura
• Empyema is pus in the pleural space, and the
definition includes pleural space infections
with a positive Gram stain or culture, or
parapneumonic effusions without pleural fluid
sampling.
• An underlying bacterial pneumonia is the
most common cause of empyema

48. • Diagnostic criteria for empyema are:
aspiration of grossly purulent material on
thoracentesis and at least one of the
following: thoracentesis fluid with a positive
Gram stain or culture, pleural fluid glucose
<40 milligrams/dL, pH <7.1, or lactate
dehydrogenase >1000 IU/L

49. Stages
• 1. Exudative (may be very short, <48 hours, the
free-flowing pleural effusion that is present is
amenable to chest tube drainage)
• 2. Fibrinopurulent (fibrin strands form in the
pleural fluid causing loculations, resolution of the
empyema with single chest tube drainage is
unlikely)
• 3. Organizational (takes several weeks, more
extensive fibrosis, "pleural peel" restricts lung
expansion)

50. Surgical treatment
• Acut - Tube thoracostomy, therapeutic
bronchoscopy
• Chronic – open thoracostomy, decortication of
lung, thoracoplasty, Bronchopleural fistula
closing

51. Open thoracostomy

52. decortication of lung

53. thoracoplasty

54. Bronchopleural fistula closing

55. Lung Abscess
• Lung abscess is a localized suppurative necrotizing
process occurring within the pulmonary parenchyma.
The commonest cause is aspiration pneumonia. Lung
abscess may also develop as a result of bacteremia
from a nonpulmonary source of infection, or from
pulmonary infarction. Other less common causes of
pulmonary abscess include infection as a result of
penetrating chest trauma, fungal and parasitic
infections, primary and metastatic neoplasms, and
inflammatory conditions such as Wegener
granulomatosis and sarcoidosis. Secondary lung
abscess is a lung abscess associated with malignancy,
immunosuppression, extrapulmonary infection, or
sepsis and has a mortality rate of 66% to 75%

56. Lung Abscess

57. Lung Abscess

58. Lung Abscess