Pulmonary Contusion

Question 1

General Considerations:

• Are injuries of the lung parenchyma with hemorrhage and edema without associated laceration.
• Most frequent intrathoracic injuries in non-penetrating chest trauma.
• They occur in approx. 30-75% of patients with significant blunt chest trauma.
• Typically occur at the site of impact.
• Often associated with other thoracic injuries such as rib fractures and flail chest, although they may occur alone.
• Pneumonia is the most common complication.
• Presence of it is a risk factor for the development of acute respiratory distress syndrome and long-term disability.
• Can be silent

Answer 1

Pulmonary Contusion

Question 2

Physical Findings:

• Is often silent during the initial trauma evaluation.
• Significant traumatic mechanism and presence of other associated thoracic and extra thoracic injuries should raise suspicion for this.
• The most important sign of it is hypoxia.
• The degree of hypoxemia directly correlates with the size of the contusion.
• Large contusions will lead to significant respiratory distress.

Answer 2

Pulmonary Contusion

Question 3

Physical Findings:

Other findings suggestive of pulmonary contusion:
* Dyspnea
* Hemoptysis
* Tachycardia

Other evidence of chest injury:
* Palpable rib fractures
* Chest wall bruising
* Decreased breath sounds
* Crackles on pulmonary auscultation

Answer 3

Pulmonary Contusion

Question 4

Lab/Imaging:

• Radiographic findings by CXR may range from patchy interstitial infiltrates to complete lobar opacification. ( fluid )
• CXR will miss a substantial number of it.
• As a result of ongoing hemorrhage and edema, radiographic evidence of contusion is usually apparent within 6h of injury.
• Since the size of contusion may help predict clinical course for a patient, thoracic CT may provide additional useful information.

Answer 4

Pulmonary Contusion

Question 5

Treatment:

Early recognition and treatment essential to preventing long-term complications.
Mainstay of treatment is supportive care:
Careful use of IVF to keep the patient euvolemic

Oxygen
* 2 - 15 L/min based on oxygen saturation and respiratory effort.t
* Delivered through nasal cannula, simple mask, non-rebreather mask, or advanced airway.

Chest physiotherapy
If severe, the use of mechanical ventilation with positive end-expiratory pressure

Disposition:
Medical Evacuation (MEDEVAC)
CXR evidence or clinical findings suggestive of this should be admitted for monitoring and respiratory support.

Answer 5

Pulmonary Contusion