Injuries of various kinds as a result of a traffic accident, falls from a height lead to fractures of the ribs, bruises of the chest. The largest organs in this region are the lungs. Therefore, they are at risk for chest injuries.
Post-traumatic pneumonia is a common outcome of lung tissue damage. It is about her that the article will be discussed.
Risk factors for disease
Bruises and injuries occur very often. But not all victims develop post-traumatic pneumonia. For this disease to occur, the influence of additional factors is necessary. The main ones are listed below:
- closed chest injury in the form of a bilateral fracture of the ribs;
- past history of lung disease;
- polytrauma - multiple injuriesthroughout the body;
- heavy condition of the victim with the development of multiple organ failure;
- getting a fat embolus (fat bubble) into the vessels of the lungs, which is a frequent complication of fractures of large bones;
- patient condition requiring multiple blood transfusions;
- concomitant heart injury;
- 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 anesthesia, violation of antiseptic rules;
- Untimely admission to the hospital (later than 6 hours after injury).
ICD-10 post-traumatic pneumonia code - J18. Moreover, in the classification, this diagnosis sounds like "Pneumonia without specifying the pathogen."
Mechanism of development of pathology
Inflammation of the lung tissue after an injury is preceded by a bruised lung. This is a closed damage to an organ, which is not manifested by a significant change in its structure, but the blood supply to the bruised area of the organ is disrupted. The lung tissue at the site of injury becomes full-blooded, the capillaries expand, and small hemorrhages occur in the parenchyma.
There is stagnation of blood in the organ, its liquid part comes out of 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 inalveoli, 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 collect in the alveoli and lead to the development of an inflammatory process. This is how post-traumatic pneumonia manifests itself (ICD-10 code - J18).
Causes of disease
In the ICD, post-traumatic pneumonia refers to a disease that can be caused by these microorganisms:
- gram-positive bacteria - streptococcus, staphylococcus, pneumococcus;
- gram-negative bacteria - Pseudomonas aeruginosa, Klebsiella;
- viruses - adenovirus, respiratory syncytial virus, influenza virus.
It is possible to assume the etiology of the disease depending on the state of immunity of the victim, as well as the place of his stay at the time of infection. So, if a patient develops pneumonia while in the hospital, Gram-negative bacteria are most likely the causative agents. The patient's stay in the intensive care unit on artificial lung ventilation indicates a probable infection with Haemophilus influenzae. If the victim fell ill at home, the causative agents of such pneumonia are most likely gram-positive microorganisms.
If the patient has a confirmed immunodeficiency state, the pathogen is most likely to be fungal (pneumocyst) or viral (cytomegalovirus).
This division of post-traumatic pneumonia in the ICD-10 by pathogens allows you to choose the most effective antibiotic therapyuntil seeding results.
Stages of the course of the disease
Most often, the first symptoms of the disease appear a few days after the injury episode. 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.
The symptoms of post-traumatic pneumonia are no different from the manifestations of normal inflammation. Three phases are distinguished in its course:
- initial - increased lung filling with blood, edema;
- densification of lung tissue - accumulation of inflammatory fluid in the alveoli;
- resolution - recovery of the patient.
Clinical manifestations
It is important to understand that the symptoms of pneumonia itself are different from those that occur due to traumatic lung injury. The most typical manifestations of the disease are:
- Cough - dry at first, sputum begins to come out at the stage of recovery.
- Sputum production in the resolution phase, which has impurities of pus and streaks of blood.
- Shortness of breath - occurs when the alveoli fill with inflammatory fluid. Eat both at rest and during exercise.
- Chest pain - develops if the inflammatory process passes to the pleura or is directly related to injury.
- Disturbance of the general condition: high body temperature, sweating, weakness, chills, loss of appetite, weight loss.
If the injury was severe, in the first place in patients ischest pain that worsens with inspiration. This is due to the fact that during the inhalation phase the lungs expand and the chest expands.
Symptoms of respiratory failure
If post-traumatic pneumonia is not treated in time, a serious complication occurs - 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 shortness of breath (breath rate over 30 per minute at a rate of 16-18);
- participation of the muscles of the shoulder girdle and neck in breathing, which indicates the need to make more efforts to inhale;
- changing the color of the skin to cyanotic;
- increase in heart rate (tachycardia) followed by its 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).
During percussion, dullness of 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.
During auscultation in the initial stages, moist rales and crepitations are heard. These are the sounds that appearon exhalation when straightening the alveoli with exudate (inflammatory fluid). In the advanced stages, the weakening of breathing 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 the following additional examination methods:
- general and biochemical blood tests;
- general urinalysis;
- bacteriological examination of sputum or bronchial washings;
- plain chest x-ray;
- bronchoscopy;
- CT and MRI.
In the general and biochemical analysis of blood, signs of an acute inflammatory process are determined:
- an increase in the number of white blood cells (leukocytosis) due to neutrophils (neutrophilia),
- increased erythrocyte sedimentation rate,
- increased levels of C-reactive protein.
During bacteriological examination of sputum, it is sown 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 antibiotic therapy.
Plain chest x-ray is performed in two projections: direct and lateral. This is necessary to accurately determine the location of inflammation, since in direct projection, part of the lung is covered by the shadow of the heart. post-traumatic pneumoniax-ray is displayed as a darkening with fuzzy contours and an inhomogeneous structure. With the accumulation of fluid in the pleural cavity, a uniform blackout with an oblique border on top is visualized.
Bronchoscopy is not a mandatory method for diagnosing pneumonia. It can be carried out both for diagnostic purposes in case of suspected violations of the structure of the bronchi, and for therapeutic purposes. In the second case, it is done to evacuate viscous sputum, which is difficult for the patient to cough up.
Computed tomography and magnetic resonance imaging are done in extreme cases, when there are ambiguities after the above examination methods.
Symptoms and treatment of post-traumatic pneumonia cannot be compared without laboratory and instrumental diagnostics. Mandatory methods are blood tests, chest x-rays and sputum cultures.
Main goals of treatment
Since there is no separate code in the ICD for post-traumatic pneumonia, its treatment is carried out according to the protocols for ordinary pneumonia.
The main tasks in the treatment of the disease are:
- inhibition of pathogen reproduction;
- improvement of respiratory function;
- reduce pain;
- improvement of the general condition of the patient.
The choice of a way to restore the patient's respiratory function depends on the cause of the respiratory failure. If the patient is having difficulty breathing due to pain, he is prescribed painkillers. If the level of oxygen in the blood is low, oxygen therapy is used. In case of severe impairment of the patient's respiratory functionconnected to a ventilator.
Features of antibiotic therapy
Sputum culture results only come after a few days. But antibiotic therapy should be started as early as possible. Therefore, until culture results are obtained, broad-spectrum antibiotics are prescribed. They are selected depending on the alleged pathogen according to the principles described in the relevant section of the article. This therapy is called empiric therapy.
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 the symptoms of pneumonia appeared during a stay in a medical institution, the antibiotics of choice will be drugs from the following groups:
- cephalosporins;
- fluoroquinolones;
- carbapenems - "Imipenem", "Meropenem";
- aminoglycosides - "Amicacin";
- tricyclic glycopeptides - "Vancomycin".
Since the 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 Biseptol 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 - "Muk altin", "Ambroxol";
- detoxification therapy - saline infusions;
- oxygen therapy;
- drugs to enhance the immune response - "Bronchomunal";
- painkillers - anti-inflammatory drugs, non-narcotic and narcotic analgesics.
Surgical or medical treatment of traumatic chest injury is carried out 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 went to the hospital, the shorter the recovery period.
According to statistics, the average length of stay in hospital for patients with uncomplicated pneumonia is 9 days, complicated - 14 days.
The 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.
