Pulmonary contusion

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Background

  • direct damage to lung causing alveolar hemor & edema & mucus/debris accumulation


Diagnosis

  • pts= sob, tachy, cyanosis, low bp, rales, hypoxia, wide a-A
  • cxr= patchy irregular infiltrates, always see by 4-6 hr, always worse than 1st xr shows!
  • CXR does NOT give clues to physiologic effects of contusion (ie, Rx pt & sx NOT CXR, even small contusion can be bad, watch pt sats & abg!!)
  • flail chest= 2 or more rib fx @ 2 or more points, problem w/ this is the underlying contusion almost 100% hve!


Treatment

  • Rx= peep b/c response to O2 is poor, intubate prn & low TV & high PEEP vent setting has become standard practice!
  • if possible intubate each side b/c peep can blow out lung + may need diff settings for ea lung.
  • steroids improve cxr but NOT outcome, abx iff aspiration o/w no chng in outcome


See Also

(Burbulys 2004/Trauma Reports 4/04 /A-Digest 7/04) -by Lampe

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