Wounds of various kinds due to a traffic accident, falls from a height lead to fractures of the ribs, bruises of the chest. The largest organs in this area are the lungs. Therefore, it is they who are at risk for chest injuries.
A frequent outcome of lung tissue damage is post-traumatic pneumonia. It is about her that the article will be discussed.
Disease risk factors
Bruises and injuries occur very often. But not all victims develop post-traumatic pneumonia. For this disease to occur, additional factors are necessary. The main ones are listed below:
- closed chest damage in the form of a bilateral fracture of the ribs;
- past lung diseases
- polytrauma - multiple injuries throughout the body;
- severe condition of the victim with the development of multiple organ failure;
- ingress of a fat embolus (fat vesicle) into the vessels of the lungs, which is a frequent complication of fractures of large bones;
- the patient's condition, requiring multiple blood transfusions;
- concomitant wound of the heart;
- accumulation of air or blood in the pleural cavity (the space surrounding the lungs), which is called pneumothorax and hydrothorax, respectively;
- poorly provided first aid: inadequate pain relief, violation of antiseptic rules;
- untimely hospitalization in the hospital (later than 6 hours after the injury).
The ICD-10 post-traumatic pneumonia code is J18. Moreover, in the classification, this diagnosis sounds like "Pneumonia without specifying the pathogen."
The mechanism of development of pathology
Inflammation of the lung tissue after injury is preceded by a bruise of the lung. This is a closed organ damage, which is not manifested by a significant change in its structure, but the blood supply to the bruised organ site is disrupted. The lung tissue at the site of the injury becomes full-blooded, the capillaries expand, there are small hemorrhages in the parenchyma.
There is stagnation of blood in the organ, its liquid part leaves the vessel into the surrounding tissue. Pulmonary edema develops. When the fluid has accumulated in large quantities, it begins to penetrate into the respiratory sacs - the alveoli.
The mucus that collects in the alveoli disrupts the flow of oxygen into the body and the removal of carbon dioxide from it. It is also a good breeding ground for microorganisms. Bacteria and viruses gather in the alveoli and lead to the development of the inflammatory process. This is how post-traumatic pneumonia manifests itself (ICD-10 code - J18).
Causes of the disease
In the ICD, post-traumatic pneumonia means a disease that can be caused by such microorganisms:
- gram-positive bacteria - streptococcus, staphylococcus, pneumococcus;
- gram-negative bacteria - Pseudomonas aeruginosa, Klebsiella;
- viruses - adenovirus, respiratory syncytial virus, influenza virus.
It can be assumed the etiology of the disease, depending on the state of immunity of the victim, as well as his place of residence during infection. So, if the patient fell ill with pneumonia while in the hospital, the most likely pathogens are gram-negative bacteria. The patient's stay in the intensive care unit on mechanical ventilation indicates a likely infection with a hemophilic bacillus. If the victim fell ill at home, the causative agents of such pneumonia are most likely gram-positive microorganisms.
If the patient has an immunodeficiency state, the pathogen is most likely to be of fungal origin (pneumocyst) or viral (cytomegalovirus).
This division of post-traumatic pneumonia in the ICD-10 by pathogen allows you to choose the most effective antibiotic therapy before the results of sowing.
Stages of the disease
Most often, the first symptoms of the disease appear a few days after an episode of injury. Then they are called early. Much less often, the disease makes itself felt more than 5 days after the injury. Such pneumonia is called late.
Symptoms of post-traumatic pneumonia are no different from the manifestations of ordinary inflammation. In its course, three phases are distinguished:
- initial - an increase in the filling of the lung with blood, edema;
- compaction of the lung tissue - the accumulation of inflammatory fluid in the alveoli;
- permission - the recovery of the patient.
Clinical manifestations
It is important to understand that the symptoms of pneumonia proper are different from those that occur due to traumatic lung damage. The most characteristic manifestations of the disease are:
- Cough - first dry, at the stage of recovery, sputum begins to pass.
- Sputum production in the resolution phase, which has impurities of pus and blood streaks.
- Shortness of breath - occurs when the alveoli are filled with inflammatory fluid. There is both at rest and during exercise.
- Chest pain - develops if the inflammatory process goes to the pleura or is directly related to the injury.
- Violation of the general condition: high body temperature, sweating, weakness, chills, loss of appetite, weight loss.
If the injury was severe, the first place in patients is pain in the chest, which increases with inhalation. This is due to the fact that during the inhalation phase, the lungs expand and the chest expands.
Symptoms of Respiratory Failure
If timely treatment of post-traumatic pneumonia is not carried out, a serious complication arises - acute respiratory failure. This is a condition in which the lungs cannot provide the body with the necessary amount of oxygen.
Signs of acute respiratory failure are:
- progression of dyspnea (respiratory rate of more than 30 per minute with a norm of 16-18);
- the participation of the muscles of the shoulder girdle and neck in breathing, which indicates the need to exert more effort for inspiration;
- discoloration of the skin to cyanotic;
- increased heart rate (tachycardia) with subsequent failure (arrhythmia);
- rapid breathing subsequently slows down, as does the heart rate.
Objective Examination Data
To make an accurate diagnosis, after talking with the patient and collecting complaints, the doctor proceeds to an objective examination. It includes two main elements: percussion (tapping) and auscultation (listening).
With percussion, dullness of the sound over the area of inflammation is determined. This is due to the compaction of the lung tissue and the accumulation of exudate. And, as you know, liquid conducts sound worse than air.
With auscultation in the initial stages, moist rales and crepitations are heard. These are sounds that appear on the exhale when the alveoli straighten with exudate (inflammatory fluid). In the advanced stages, weakening of respiration over the affected area of the lung or its complete absence is determined.
Additional diagnostic methods
To make an accurate diagnosis of post-traumatic pneumonia, the doctor prescribes these additional examination methods:
- general and biochemical blood analysis;
- general urine analysis;
- bacteriological examination of sputum or rinsing water of the bronchi;
- chest x-ray;
- bronchoscopy;
- computed and magnetic resonance imaging.
In a general and biochemical blood test, signs of an acute inflammatory process are determined:
- increase in the number of leukocytes (leukocytosis) due to neutrophils (neutrophilia),
- increase in erythrocyte sedimentation rate,
- increased levels of C-reactive protein.
When bacteriological examination of sputum is carried out its sowing on a nutrient medium. In the future, it is determined which bacteria grew on this medium. This examination allows you to accurately determine the causative agent of the disease and prescribe effective antibacterial therapy.
Panoramic x-ray of the chest is carried out in two projections: direct and lateral. This is necessary to accurately determine the localization of inflammation, since in a direct projection part of the lung is covered by the shadow of the heart. X-ray post-traumatic pneumonia is displayed as blackout with fuzzy contours and a heterogeneous structure. With the accumulation of fluid in the pleural cavity, a uniform darkening is visualized with an oblique border from above.
Bronchoscopy is not a mandatory diagnostic tool for pneumonia. It can be carried out both for diagnostic purposes in case of suspected violation of the structure of the bronchi, and for treatment. In the second case, it is done to evacuate viscous sputum, which is difficult for the patient to cough.
Computed and magnetic resonance imaging are done in extreme cases, when there are ambiguities after the above survey methods.
Symptoms and treatment of post-traumatic pneumonia cannot be compared without laboratory and instrumental diagnostics. Mandatory methods are blood tests, chest x-ray, and sputum culture.
The main objectives of the treatment
Since post-traumatic pneumonia does not have a separate code in the ICD, its treatment is carried out according to the protocols for conventional pneumonia.
The main tasks in the treatment of the disease are:
- inhibition of reproduction of the pathogen;
- improved respiratory function;
- decrease in pain;
- improving the general condition of the patient.
The choice of a method for restoring the patient's respiratory function depends on the cause of respiratory failure. If the patient has difficulty breathing due to pain, he is prescribed pain medication. If the blood oxygen level is reduced, oxygen therapy is used. In severe violation of the respiratory function of the patient is connected to a ventilator.
Features of antibiotic therapy
Sputum culture results come only after a few days. But antibiotic therapy should be started as early as possible. Therefore, antibiotics of a wide spectrum are prescribed before the results of sowing. They are selected depending on the intended pathogen according to the principles described in the corresponding section of the article. Such therapy is called empirical.
If pneumonia occurs at home, choose an antibiotic from the following groups:
- synthetic penicillins - "Amoxicillin", protected by clavulanic acid - "Amoxiclav";
- cephalosporins of the third - fourth generations - "Ceftriaxone", "Cefuroxime";
- fluoroquinolones - Ofloxacin, Levofloxacin.
If symptoms of pneumonia appear during a stay in a medical institution, drugs from the following groups will be the antibiotics of choice:
- cephalosporins;
- fluoroquinolones;
- carbapenems - "Imipenem", "Meropenem";
- aminoglycosides - Amikacin;
- tricyclic glycopeptides - Vancomycin.
Since pathogens that occur in the hospital are resistant to many antibiotics, it is advisable to prescribe several drugs at the same time. For example, Cefepim and Levofloxacin, Amikacin and Vancomycin.
If pneumonia occurs in a person with immunodeficiency syndrome, the appointment of "Biseptolum" and "Pentamidine" is mandatory.
Symptomatic therapy
Symptoms and treatment of post-traumatic pneumonia in adults are directly related. Therapy aimed at alleviating the clinical manifestations of the disease is called symptomatic. For the treatment of post-traumatic pneumonia, the following drugs are prescribed:
- mucolytics - Mukaltin, Ambroxol;
- disinoxication therapy - infusion of saline solutions;
- oxygen therapy;
- drugs to increase the immune response - Bronchomunal;
- painkillers - anti-inflammatory drugs, non-narcotic and narcotic analgesics.
Surgical or drug treatment of traumatic injury to the chest is performed separately.
Recovery period
The prognosis and duration of recovery after traumatic pneumonia depends on the timeliness of seeking help and the correctness of treatment. The earlier the patient turned to the hospital, the shorter the recovery period.
According to statistics, the average length of hospital stay for patients with uncomplicated pneumonia is 9 days, and complicated for 14 days.
Statistics of recovery from post-traumatic pneumonia without complications was 99%, with complications - 94%. Moreover, all deceased patients are admitted to the hospital in serious condition, with severe respiratory distress.