n. an injury or physical trauma.
Lung trauma or contusion
Inhalation of toxic gases or smoke
ASPIRATION of gastric contents
Near-drowning... direct insult
METABOLIC DISORDERS such as URAEMIA and pancreatitis (see PANCREAS, DISORDERS OF)
Bowel infarction
Drug ingestion
Massive blood transfusion, transfusion reaction (see TRANSFUSION OF BLOOD), CARDIOPULMONARY BYPASS, disseminated intravascular coagulation
Treatment The principles of management are supportive, with treatment of the underlying condition if that is possible. Oxygenation is improved by increasing the concentration of oxygen breathed in by the patient, usually with mechanical ventilation of the lungs, often using continuous positive airways pressure (CPAP). Attempts are made to reduce the formation of pulmonary oedema by careful management of how much ?uid is given to the patient (?uid balance). Infection is treated if it arises, as are the possible complications of prolonged ventilation with low lung compliance (e.g. PNEUMOTHORAX). There is some evidence that giving surfactant through a nebuliser or aerosol may help to improve lung e?ectiveness and reduce oedema. Some experimental evidence supports the use of free-radical scavengers and ANTIOXIDANTS, but these are not commonly used. Other techniques include the inhalation of NITRIC OXIDE (NO) to moderate vascular tone, and prone positioning to improve breathing. In severe cases, extracorporeal gas exchange has been advocated as a supportive measure until the lungs have healed enough for adequate gas exchange. (See also RESPIRATORY DISTRESS SYNDROME; HYALINE MEMBRANE DISEASE; SARS.)... indirect insult
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