Pulmonary contusion: Difference between revisions

Revision as of 04:13, 17 July 2011

Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
Flail chest almost always associated w/ contusion

Areas of lung opacification on chest imaging w/in 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 a/w 80% risk of developing ARDS

Authors:

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 ==Background==
-*Direct damage to lung causing alveolar hemorrhage, edema, and debris accumulation
+*Direct injury to lung resulting in hemorrhage and edema in absence of lung laceration
+*Flail chest almost always associated w/ contusion
 ==Diagnosis==
 *Signs/symptoms
-**SOB
+**Dyspnea
 **Tachypnea
-**Cyanosis
+**Chest pain
-**Hypotension
+**Coarse breath sounds
-**Rales
 **Hypoxia
-**Wide a-A
+**Widened A-a gradient
 ==Imaging==
+*Areas of lung opacification on chest imaging w/in 6hr of blunt trauma is diagnostic
 *CXR
 **Patchy irregular infiltrates
-**Always seen by 4-6 hr, always worse than what the 1st CXR shows
+*CT
-***Do not treat the CXR, treat the patient
+**Ground-glass opacities in mild-moderate contusions, widespread consolidation if severe
-**Flail chest almost always associated with contusion
+**May pick up 70% of contusions not seen on CXR
+**Contusion >20% of lung volume a/w 80% risk of developing ARDS
 ==Treatment==
-*If need to intubate: low tidal volume, high PEEP
+*Ensure adequate ventilation
+**Analgesia
+**Ventilatory Assistance
+***Pts w/ >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
 ==See Also==
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 ==Source==
-*Trauma Reports 4/04
+*Tintinalli
 [[Category:Pulm]]
 [[Category:Trauma]]