Pediatric emergency medicine trisk 3705 3705

While a stable pulmonary contusion may not require any specific therapy, patients
are at high risk of deteriorating respiratory status and therefore require an
expedited evaluation. In addition, the presence of such an injury indicates that
sufficient force was applied to the thorax to warrant thorough evaluation for
additional injuries.
Clinical Assessment
Initial assessment should focus on assessing and stabilizing the airway, breathing,
and circulation, as well as the identification of other associated injuries. Vital sign
abnormalities seen with moderate to severe pulmonary contusions may include
tachypnea and hypoxemia due to shunting within the lung. Patients may complain
of chest pain or shortness of breath, and physical examination may reveal chest
wall bruising and tenderness, with focally diminished breath sounds in the
affected lung. These latter findings are nonspecific, however, and their absence
should not be used to rule out pulmonary contusion without imaging.

FIGURE 115.4 Right lower lobe pulmonary contusion in a patient with associated rib fractures.
Subcutaneous air is also noted in the adjacent soft tissue.

Management