II. Epidemiology
- Pulmonary Contusion is the most common potentially lethal Chest Injury
III. Risk Factors: Increased Morbidity
IV. Causes
V. Pathophysiology
-
Traumatic Injury to chest results in Lung Contusion
- May occur without Rib Fracture
- Alverolar capillary damage occurs with Blunt Chest Trauma
- Alveolar space accumulation of blood and fluid with decreased lung compliace and lung injury
- Results in ventilation-Perfusion Mismatch (VQ Mismatch) and intrapulmonary shunting
- Slow, insidious Respiratory Failure with secondary Hypoxia
VI. Signs
VII. Imaging
-
Chest XRay
- Initially underwhelming compared to clinical status for first 6 hours
- Alveolar Infiltrates not limited to lobar boundaries (peak appearance at 48 hours after injury)
- CT Chest
- Defines region of lung injury
VIII. Indications: Management
- Early Endotracheal Intubation Indications despite Supplemental Oxygen
- Arterial Blood Gas with PaO2 <65 mmHg or
- Oxygen Saturation <90%
- Admit most patients (especially elderly)
- Respiratory distress peaks at 48-72 hours
- Respiratory status can deteriorate rapidly
- Discharge indications
- Young, healthy, stable and compliant patient AND
- Near normal Chest XRay AND
- Will perform incentive Spirometry at home frequently (every 1-2 hours) AND
- Has close, reliable follow-up scheduled
IX. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21