Pulmonary Contusion

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DEFINITION
Contusion of the lung as a result of a traumatic insult, impairing ventilation.
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EPIDEMIOLOGY
Most common potentially lethal chest injury.
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AETIOLOGY
Trauma.
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BIOLOGICAL BEHAVIOUR

Pathophysiology
Contused lung establishes a ventilation / perfusion mismatch.
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MANIFESTATIONS
Respiratory failure, which may be subtle, developing over time.

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INVESTIGATIONS
See below

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MANAGEMENT

Because the respiratory failure develops over time, careful monitoring and reevaulation is required.
Oximetry, ECG, ABG are necessary adjuncts.

Intubation
For pts with significant hypoxia, eg PO2 <65mmHg or SaO2<90% on room air.
Intubate and ventilate within first hour of injury.
Associated medical conditions, eg pulmonary disease, renal failure increase this need.
Some pts may be managed selectively without intubation.

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REFERENCES
ATLS

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