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Pulmonary Barotrauma


Presentation

  • Pulmonary barotrauma was not contemplated because of the relatively mild presentation. Later, a very significant pneumothorax was discovered and successfully treated without sequelae.[ncbi.nlm.nih.gov]
Falling
  • This seems to indicate that if a diver surfaces with chest pain, stroke-like symptoms, immediately falls unconscious, or manifests other symptoms within a minute or two of surfacing, pulmonary barotrauma should be suspected.[thoughtco.com]
  • The pulse is difficult to feel as the blood pressure falls.[cfua.org]
  • BPD, those who had had respiratory distress syndrome but did not develop BPD, and children born at term. 61 84 103 The patients with a history of BPD, however, used a greater percentage of their ventilatory reserve and/or exhibited an exercise induced fall[thorax.bmj.com]
Gangrene
  • An incidence of 7% (23 of 322 patients) was reported in a case series of HBOT for gas gangrene.[clinicaladvisor.com]
  • In addition, recompression therapy can be used in a wide variety of medical conditions, including osteoradionecrosis, skin grafts, gas gangrene, refractory osteomyelitis, radiation induced injury, poorly healing wounds, and acute traumatic ischemic injury[aoemj.biomedcentral.com]
Pallor
  • On examination, he was mentally clear with facial pallor, tachypnea and tachycardia. His blood pressure was 70/40 mmHg. Tenderness was found on the chest but without obvious rales.[omicsonline.org]
Hyperresonance
  • Tension pneumothorax, although rare with barotrauma, can cause hypotension, distended neck veins, hyperresonance to percussion, and, as a late finding, tracheal deviation.[merckmanuals.com]
Tracheal Deviation
  • Tension pneumothorax, although rare with barotrauma, can cause hypotension, distended neck veins, hyperresonance to percussion, and, as a late finding, tracheal deviation.[merckmanuals.com]
Dysphagia
  • […] pneumothorax (causing dyspnea, chest pain, and unilateral decrease in breath sounds) or pneumomediastinum (causing sensation of fullness in the chest, neck pain, pleuritic chest pain that may radiate to the shoulders, dyspnea, coughing, hoarseness, and dysphagia[merckmanuals.com]
Distended Neck Veins
  • Tension pneumothorax, although rare with barotrauma, can cause hypotension, distended neck veins, hyperresonance to percussion, and, as a late finding, tracheal deviation.[merckmanuals.com]
Flushing
  • Therefore, use of the flush valve while a patient is connected to a nonrebreathing system transmits excess volume and pressure directly to the patient’s airway and lungs.[cliniciansbrief.com]
  • ., during central line placement, flushing, or removal. Re-immersion pulmonary edema can occur, and its mechanism is similar to negative pressure pulmonary edema.[clinicaladvisor.com]
Neck Pain
  • The result can be pneumothorax (causing dyspnea, chest pain, and unilateral decrease in breath sounds) or pneumomediastinum (causing sensation of fullness in the chest, neck pain, pleuritic chest pain that may radiate to the shoulders, dyspnea, coughing[merckmanuals.com]
Muscle Weakness
  • Symptoms of DCS (listed in decreasing order of overall prevalence): Paraesthesia, pain Constitutional symptoms Dizziness, muscle weakness Skin rash and itching Decreased coordination or mental status Pulmonary manifestations, such as wheezing and shortness[clinicaladvisor.com]
Forgetful
  • Once the button is released, flow through the valve is automatically re-established, minimizing the risk for forgetting to reopen the original pop-off valve, as it will always be left open.[cliniciansbrief.com]
  • This may be due to failure to read "Diving Medicine for Scuba Divers", panic, ignorance, forgetfulness or spasm of the larynx after inhalation of water.[cfua.org]
Aphasia
  • Signs and symptoms: Dizziness, headache Nausea, vomiting Nystagmus Chest pain Shortness of breath, hemoptysis, crepitus Stroke symptoms such as bilateral or unilateral motor or sensory changes, aphasia vertigo, ataxia, dysmetria, cortical blindness Seizures[clinicaladvisor.com]
Dysmetria
  • Signs and symptoms: Dizziness, headache Nausea, vomiting Nystagmus Chest pain Shortness of breath, hemoptysis, crepitus Stroke symptoms such as bilateral or unilateral motor or sensory changes, aphasia vertigo, ataxia, dysmetria, cortical blindness Seizures[clinicaladvisor.com]
Tonic-Clonic Seizure
  • Similar mechanism and management as barotrauma caused by diving Oxygen toxicity: Pulmonary toxicity: dysfunction of small airways may be observed when treatment duration and pressure exceed recommended therapeutic protocols CNS toxicity: generalized tonic-clonic[clinicaladvisor.com]
Altered Mental Status
  • A head CT scan should be strongly considered in any patient who has altered mental status in order to evaluate alternative diagnoses, such as subdural or epidural hematoma.[clinicaladvisor.com]

Workup

  • Besides reduced emergency medical costs and shorter hospital stays (diagnostic workups would be greatly shortened), insurers would find reduced health care costs in their capitated population because of the added efficiency and increased mortality with[scubamed.com]
Pneumoperitoneum
  • Massive pneumoperitoneum developing immediately following initiation of artificial ventilation is an unusual sign of pulmonary barotrauma, and must be distinguished from pneumoperitoneum following rupture of a hollow abdominal viscus.[ncbi.nlm.nih.gov]
  • There is also pneumoperitoneum. There is right pleural effusion and areas of higher density in the lung parenchyma corresponding to pneumonic foci. Endotracheal tube well located.[radiopaedia.org]
  • In the lung it is caused by excessive airway pressures, resulting in extra-alveolar air, as in pneumothorax, pneumomediastinum, or pneumoperitoneum. bar·o·trau·ma ( băr'ō-traw'mă ), A term previously used to describe injury to the middle ear or paranasal[medical-dictionary.thefreedictionary.com]
  • These pathways include subcutaneous tissues, where the air produces subcutaneous emphysema, or along tissue planes, resulting in pneumopericardium, pneumoperitoneum, or subpleural air cysts.[emedicine.medscape.com]

Treatment

Prognosis

  • […] for recovery from barotrauma is anticipated to be excellent; however, its effects at the time of the event and the patient’s underlying comorbidities and lung disease affect the prognosis.[emedicine.medscape.com]
  • Confinement anxiety – managed with anxiolytics Fire (due to elevated FiO2) What is the prognosis for patients managed in the recommended ways? Outcome data for SCUBA divers who suffer from DCS is compiled and published by the Diver’s Alert Network.[clinicaladvisor.com]
  • Outlook (Prognosis) Barotrauma is usually noncancerous ( benign ) and responds to self-care. Hearing loss is almost always temporary. When to Contact a Medical Professional Try home care measures first.[mountsinai.org]
  • Prognosis Mortality rates vary widely.[patient.info]

Etiology

  • Initial evaluations considered decompression sickness and musculoskeletal etiologies. Pulmonary barotrauma was not contemplated because of the relatively mild presentation.[ncbi.nlm.nih.gov]
  • They suggest that the etiology of the decompression disorders is impossible to define, the two illnesses are difficult to separate from one another, and both require the same therapy.[scubamed.com]
  • Etiology Barotrauma is one of the manifestations of VILI.[emedicine.medscape.com]

Epidemiology

  • Having identified some caveats with respect to the diagnosis of the condition and discussed the routes which air may take having left the intra-pulmonary air spaces, the epidemiology of the condition in the contexts of diving and submarine escape is discussed[archive.rubicon-foundation.org]
  • Epidemiology Frequency depends on both the political stability of the region, eg terrorism, and local factors such as occupational health and safety priorities. Presentation Lungs may show evidence of pulmonary trauma and pneumothorax.[patient.info]
  • Epidemiologic data pertinent to divers have traditionally not been recorded in sufficient detail to allow a more specific classification.[scubamed.com]
  • Epidemiology United States statistics The incidence of barotrauma in mechanically ventilated patients varies widely and is reported to be as low as 0.5% in postoperative patients and as high as 87% in patients with ARDS.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This report cites four cases demonstrating different mechanisms by which pulmonary barotrauma can be caused during CPR, and reviews their pathophysiologic consequences.[ncbi.nlm.nih.gov]
  • DCS pathophysiology: Under normal conditions, we breathe air at 1 atmospheres absolute (ATA), which is the average atmospheric pressure at sea level.[clinicaladvisor.com]
  • These terms are unambiguous and perfectly appropriate for denoting the pathophysiologic concepts for which they were defined.[scubamed.com]
  • Here we describe the causative agents (shock) and the consequences (sepsis, organ failure) in two main sections, divided on the basis of their pathophysiology.[books.google.es]

Prevention

  • It is concluded that the Royal Navy policy of preventing all divers who suffer PBT from further diving is justified, regardless of the cause or mild nature of the injury.[ncbi.nlm.nih.gov]
  • A thoracostomy tube should then be placed to allow air to be continuously removed until the ruptured alveoli can seal to prevent the reoccurrence of a tension pneumothorax.[cliniciansbrief.com]
  • Prevention of pulmonary barotrauma is usually the top priority. Proper ascent timing and techniques are essential.[merckmanuals.com]
  • Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation.[books.google.com]
  • Rescue procedure in the case of an occurrence of pulmonary barotrauma, methods of prevention.[degruyter.com]

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