Lung lesions after prolonged shock
Introduction
Introduction Shock lung (shocklung) means that the lung may have severe interstitial and alveolar pulmonary edema, hemorrhage, localized atelectasis, microcapillary formation in the capillary, and alveolar transparent membrane formation. These features of the lungs are called shock lungs. Because of the shock, respiratory dysfunction occurs. For the wounded and sick who may have shock, the corresponding preventive measures should be taken for the cause. Temporary and accurate first aid treatment should be carried out for the wounded and sick.
Cause
Cause
Causes of pulmonary lesions after a longer shock:
If the lung dysfunction is mild, acute lung injury will occur, and if it is heavy, it will lead to systemic inflammatory response syndrome.
The mechanism is as follows: 1. The lung is a whole body blood filter, and the metabolites are extracted from the whole body tissues. The active substances and foreign substances in the blood are passed through or even blocked in the lungs; 2. The activated neutrophils in the blood also flow. The small blood vessels of the lungs adhere to the endothelial cells as early as possible; 3. The lungs contain macrophages, which are activated during systemic inflammatory reactions, producing inflammatory mediators such as tumor necrosis factor, causing inflammatory reactions. The systemic inflammatory response syndrome used to be called shock lung.
Examine
an examination
Related inspection
Electrocardiogram, routine urine, urinary leucine, leucine, aminopeptidase
Examination of lung lesions after a longer shock:
(1) Blood routine: Red blood cells and hemoglobin are significantly reduced after a large number of bleedings; blood loss occurs in patients with dehydration, red blood cell count increases, and hematocrit increases. The white blood cell count is generally increased. Most of the severely infected patients have a significant increase in the total number of white blood cells and neutrophils, and eosinophils can be reduced. If there is bleeding tendency and diffuse intravascular coagulation, platelet count can be reduced, fibrinogen can be reduced, prothrombin time can be prolonged, plasma protamine paracoagulation test (3P test) or ethanol gel test is positive.
(2) Blood chemistry: blood sugar is increased, blood pyruvic acid and lactic acid are increased, and the pH value is lowered, the alkali reserve is lowered, and the carbon dioxide binding force is lowered. When renal function declines, there may be an increase in blood urea nitrogen and non-protein nitrogen. Blood potassium can also increase. When liver function declines, blood transaminase, lactate dehydrogenase, etc. can be increased, and blood ammonia can be increased in liver failure. Arterial oxygen saturation and venous blood oxygen content can be reduced. In pulmonary failure, arterial oxygen partial pressure is significantly reduced, and pure oxygen can not return to normal.
(3) Urine routine: Protein, red blood cells and casts may appear in the urine as the kidney changes.
(4) Electrocardiogram: There may be a manifestation of insufficient blood supply to the coronary arteries, such as a decrease in the ST segment, a low-level or inverted T-wave, or even a change similar to myocardial infarction. The original heart disease can also have a corresponding ECG change.
Diagnosis
Differential diagnosis
Identification of lung lesions that are easily confused with lung lesions after a longer shock:
(1) Cardiogenic shock:
Cardiogenic shock is most common in acute myocardial infarction. According to the clinical manifestations of electrocardiogram findings and blood myocardial enzyme examination results, the diagnosis of acute myocardial infarction is generally no problem. In the diagnosis of cardiogenic shock caused by acute myocardial infarction, the following conditions should be identified: 1 acute massive pulmonary embolism (see "Mutcular Infarction" for identification points). 2 acute pericardial tamponade. A large amount of inflammatory exudate, pus or blood appears in the pericardial cavity for a short period of time, which is caused by compression of the heart. The patient has a pericardial infection, myocardial infarction, cardiac trauma or surgical trauma. At this time, the pulse is weak or there are strange veins, the heart is enlarged but the apex is not obvious, the heart sound is far away, and the jugular vein is full. The X-ray showed that the heart-enhanced face had weak pulsation, the electrocardiogram showed low voltage or ST-segment uplift and T wave inversion, and echocardiography, X-ray CT or MRI showed that the pericardial cavity fluid could be diagnosed. 3 aortic dissection (see "myocardial infarction"). 4 rapid arrhythmia. Including atrial flutter, tremor, supraventricular or ventricular tachycardia, especially in patients with organic heart disease, ECG is helpful to identify. 5 acute aortic valve or mitral regurgitation. Infected endocarditis, heart trauma, papillary muscle dysfunction, and the like. At this time, there is acute left heart failure, and there is reflux murmur in the valve area. Echocardiography and Doppler ultrasonography can confirm the diagnosis.
(2) Hypovolemic shock:
Shock caused by acute blood volume reduction should identify the following conditions: 1 bleeding. Bleeding in the gastrointestinal tract, respiratory tract, urinary tract, and genital tract is not difficult to diagnose in vitro. Splenic rupture, liver rupture, rupture of ectopic pregnancy, rupture of aortic aneurysm, tumor rupture, etc., bleeding in the abdominal cavity or chest, not easy to be found. At this time, in addition to the clinical manifestations of shock, the patient is obviously anaemic, with signs of chest and abdominal pain and blood in the chest and abdomen. Thoracic, abdominal or vaginal puncture can help diagnose. 2 surgical trauma. It is not difficult to diagnose a history of trauma and surgery. 3 diabetic ketoacidosis or non-ketotic hyperosmolar coma. (See "Diabetes"). 4 acute hemorrhagic pancreatitis. (See "pancreatitis").
(3) Infectious shock:
Various serious infections may cause shock, the common ones are: 1 toxic bacterial dysentery. More common in children, shock may occur before the intestinal symptoms, anal swabs should be taken for fecal examination and culture to confirm the diagnosis. 2 pneumococcal pneumonia. Shock may also occur before respiratory symptoms appear. Need to be diagnosed according to chest signs and chest X-ray. 3 epidemic hemorrhagic fever. An important disease that causes septic shock. 4 fulminant meningitis diplococcus sepsis. More common in children, severe shock is one of the characteristics of this disease. 5 toxic shock syndrome. Due to staphylococcal infection, it is more common in young women to use vaginal plug during menstrual period, leading to staphylococcal reproduction and toxin absorption; also seen in children's skin and soft tissue staphylococcal infection. Clinical manifestations include hyperthermia, vomiting, headache, sore throat, myalgia, scarlet fever-like rash, watery diarrhea, and shock.
