Gunshot Lung Injury: Pulmonary Contusion, Pneumothorax, Hemothorax

Thoracic gunshot wounds cause life-threatening pulmonary injuries:

• Pulmonary contusion: Parenchymal bruise → hypoxia, pain, infiltrates.
• Pneumothorax: Pleural air → lung collapse; tension physiology = emergency needle decompression.
• Hemothorax: Blood in pleural space → hypovolemia, lung compression; chest tube drainage.
• Flail chest: ≥3 ribs fractured in ≥2 places → paradoxical motion, respiratory failure.
• Tracheobronchial injury: Air leak, subcutaneous emphysema.

**ATLS protocol:** Airway, breathing, circulation; chest tube before transport if pneumo/hemothorax; surgical exploration for massive air leak, bleeding >1500 mL initial or >200 mL/hr.