A patient presented with acute respiratory insufficiency within one week of injury. Causes may be all EXCEPT
(Shock lung): (2205-HI8th edition; 189-CSTD 13th)Contusion of the lung - used to indicate the consequences of the blunt trauma to the lung. It often occurs in rapid deceleration of the chest against an automobile steering wheel or fall from a height or in blast injuries.An associated lung contusion may produce a decrease in lung compliance not fully manifest until 12-48 hours after injury. Inadequate negative intra pleural pressure is then required for ventilation, and chest wall instability become apparent. If ventilation become inadequate, atelectasis, hypercapnia, hypoxia, accumulation of secretions and inadequate cough occurs (189-CSDT 13th)* FAT - embolism -* Occurs from long bones fractures* Triad - Respiratory insufficiency (Dyspnoea)* Encephalopathy (Confusion)* Petechial hemorrhage (upper body petechial rash)* Coagulopathy (clotting time and decreased platelets)* Tension and open pneumothorax are surgical emergencies because both ventilation and venous return of blood to the heart is compromisedSHOCK LIVER or ischaemic hepatitis - results from extreme hepatic tissue hypoxia and is characterized by contrilobular hepatocellular necrosis. Transminase levels are often massively raised (> 1000-5000 U/L) at an early stages followed by moderate hyperbilirubinaemia (<100pm or <5.8 mg/dL)There is often associated hypoglycaemia, coagulopathy and lactic acidosis. Following successful resuscitatic hepatic function generally return to normalClinical disorders commonly associated with Acute respiratory distress syndrome (2205- H18th)Direct lung injuryIndirect lung injury* Pneumonia* Aspiration of gastric contents* Pulmonary contusion* Near drowning* Toxic inhalation injury* Sepsis* Severe trauma* Multiple bone fractures* Flail chest* Head trauma* Bums* Multiple transfusions* Drug overdoses* Pancreatitis* Post cardiopulmonary bypass
Contusion of the lung
Fat embolism
Pneumothorax
Shock lung
Trauma