Pulmonary contusion: Difference between revisions
(Text replacement - "*Chest pain" to "*Chest pain") |
No edit summary |
||
| Line 4: | Line 4: | ||
==Clinical Features== | ==Clinical Features== | ||
*Dyspnea | |||
*Tachypnea | |||
*[[Chest pain]] | |||
*Coarse breath sounds | |||
*Hypoxia | |||
*Widened A-a gradient | |||
==Evaluation== | ==Evaluation== | ||
*Areas of lung opacification on chest imaging within 6hr of blunt trauma is diagnostic | *Areas of lung opacification on chest imaging within 6hr of blunt trauma is diagnostic | ||
*[[CXR]] | *[[CXR]] | ||
| Line 36: | Line 34: | ||
****Low tidal volume, high PEEP | ****Low tidal volume, high PEEP | ||
*Avoid unnecessary fluid administration | *Avoid unnecessary fluid administration | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Rib Fracture]] | *[[Rib Fracture]] | ||
Revision as of 23:18, 22 October 2017
Background
- Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
- Flail chest almost always associated with contusion
Clinical Features
- Dyspnea
- Tachypnea
- Chest pain
- Coarse breath sounds
- Hypoxia
- Widened A-a gradient
Evaluation
- Areas of lung opacification on chest imaging within 6hr of blunt trauma is diagnostic
- CXR
- Patchy irregular infiltrates
- CT
- Ground-glass opacities in mild-moderate contusions, widespread consolidation if severe
- May pick up 70% of contusions not seen on CXR
- Contusion >20% of lung volume associated with 80% risk of developing ARDS
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Pulmonary Edema Types
Pulmonary capillary wedge pressure <18 mmHg differentiates noncardiogenic from cardiogenic pulmonary edema[1]
- Cardiogenic pulmonary edema
- Noncardiogenic pulmonary edema
- Negative pressure pulmonary edema
- Upper airway obstruction
- Reexpansion pulmonary edema
- Strangulation
- Neurogenic causes
- Iatrogenic fluid overload
- Multiple blood transfusions
- IV fluid
- Inhalation injury
- Pulmonary contusion
- Aspiration pneumonia and pneumonitis
- Other
- High altitude pulmonary edema
- Hypertensive emergency
- ARDS
- Flash pulmonary edema
- Immersion pulmonary edema
- Hantavirus pulmonary syndrome
- Missed dialysis in kidney failure
- Naloxone reversal
- Negative pressure pulmonary edema
Management
- Ensure adequate ventilation
- Analgesia
- Ventilatory Assistance
- Patients with >25% of lung involvement frequently require ventilatory assistance
- NIV may be tried
- Intubate if NIV fails
- Low tidal volume, high PEEP
- Avoid unnecessary fluid administration
Disposition
See Also
References
- ↑ Clark SB, Soos MP. Noncardiogenic Pulmonary Edema. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2020.