Pulmonary Contusion

A blunt thoracic trauma

 What is a Pulmonary Contusion?

It is the damage caused to the lung tissues when there is rapid

compression and decompression to the chest wall, resulting in
hemorrhage and localized edema.

Leads to the development of infiltrates

and various degrees of respiratory
dysfunction – sometimes, respiratory
failure.

Often cited as the most common

potentially life-threatening chest injury.
 What causes Pulmonary Contusions?
Direct blunt force to the chest Explosion injuries –
Common causes: vehicular accidents, falls, common during
sports injuries, physical assaults blast incidents at
war zones

Shock associated with penetrating trauma

 Pathophysiology
Injury to the lung Blood, fluids, and cellular
parenchyma and its debris enter the lungs and
capillary network results in accumulate in bronchioles and
a leakage of serum protein alveoli, interfering with gas
and plasma. exchange.

01 02 03 04

Pulmonary vascular
The leaking serum protein
resistance and pulmonary
exerts an osmotic pressure
artery pressure increases –
that enhances loss of fluid
leading to hypoxemia and
from the capillaries.
carbon dioxide retention.
 Clinical Manifestations

Mild Moderate Severe

•Decreased breath •Severe tachypnea •Central cyanosis
sounds •Severe tachycardia •Marked agitation /
•Tachypnea •Crackles combativeness
•Tachycardia •Large amounts of •Productive cough –
•Chest pain mucus with frothy, bloody
•Hypoxemia •Frank bleeding secretions
•Blood-tinged secretions •Severe hypoxemia – •Other signs/symptoms
with cyanosis, mild that mirror ARDS
agitation, irrational
behavior
•Respiratory acidosis
 Assessment and Diagnostics
Imaging Studies
View structures and organs in the
Pulse Oximetry chest (e.g. X-ray, CT Scan, UTZ)
Measure oxygen
saturation

Arterial Blood Gas

Assess efficiency of
gas exchange
 Medical Management

Non-invasive Pharmacotherapy Invasive Therapies

Therapies • Opioid analgesics • Endotracheal suctioning
• Lung volume • Intercostal nerve • Bronchoscopy
expansion techniques • Endotracheal intubation
blocks Mechanical ventilation
• Postural drainage •

• Physiotherapy – • Prophylactic • Nasogastric intubation –

coughing techniques antibiotics to relieve GI distention
• Oxygen • Diuretics
administration
 Nursing Management

Assessment Possible Diagnoses

• History of Present Injury
• Pain
• Vital signs w/ pulse oximetry
• Breath and heart sounds
• Early detection of respiratory
distress
• Ecchymosis at the site of injury
• Cough with blood-tinged sputum
• Acute pain
• Ineffective airway clearance
• Ineffective breathing pattern
• Impaired gas exchange
• Decreased cardiac output
• Impaired tissue integrity
• Ineffective peripheral tissue
perfusion
• Risk for infection

Priorities: maintain airway; adequate oxygenation; control pain

 Nursing Management
Interventions
• Monitor quality of respirations
• Prone position or “good lung down” position
• Provide patient comfort and support
• Facilitate breathing exercises
• Educate patient re: condition and course of treatment
• Oxygen therapy
• Administer medications as ordered
• Coordinate with respiratory therapist for implementation of chest
physiotherapies

Priorities: maintain airway; adequate oxygenation; control pain

Penetrating Trauma
Foreign object through the chest wall
 What is a Penetrating Trauma?

A classification of chest trauma wherein a foreign object penetrates

the thoracic wall (e.g. stabbing and gunshot wound).

Usually accompanied w/ pneumothorax and cardiac tamponade.

Clinical consequences
depend on the
mechanism of injury,
location, associated
injuries, and underlying
illnesses.
What can be damaged in a Penetrating Trauma?

Any organ or structure within the chest is potentially

susceptible to traumatic penetration.
• Chest wall
• Lung and pleura
• Tracheobronchial system
• Esophagus
• Diaphragm
• Major thoracic blood
vessels
• Heart and other
mediastinal structures
 Assessment and Diagnostics
Pulse Oximetry Imaging Studies
Measure oxygen View structures and
saturation organs in the chest (e.g.
X-ray, CT Scan, UTZ)

Arterial Blood Chemistry Profile

Gas Analysis Measure the amount of
Assess efficiency of different substances in
gas exchange the blood

ECG Blood Typing &

Cross-matching
Monitor electrical
activity of the heart Preparation for a
possible transfusion
 Medical Management
• Analgesics
• Intercostal nerve blocks
Pharmacotherapy • Prophylactic antibiotics

• Colloid/crystalloid IV fluids or Blood Trans– for hemorrhagic shock

• Nasogastric intubation – to prevent aspiration, minimize leakage of
abdominal contents, and decompress the GI tract
• Thoracotomy – emergency incision into the pleural space; done when
cardiac arrest is imminent
• Thoracostomy – insertion of a chest tube to facilitate re-expansion of
Medical/Surgical
the lungs and evacuation of blood and air
Therapies • Surgery – for penetrating wounds of the heart, major blood vessels,
tracheobronchial tree, esophagus, etc.
• Operative exploration – necessary if there is continuing intrathoracic
bleeding (drainage of >1000-1500mL at once OR 200mL/hour for 2-4
hours)
 Nursing Management
Assessment Possible Diagnoses

• History of Present Injury • Acute pain

• Pain
• Vital signs w/ pulse oximetry
• Breath and heart sounds
• Early detection of resp. distress
• Signs of cardiogenic shock
• Frothy, bloody sputum
• Any indication of hemothorax /
pneumothorax / cardiac
tamponade
• Ineffective airway clearance
• Ineffective breathing pattern
• Impaired gas exchange
• Decreased cardiac output
• Impaired tissue integrity
• Ineffective peripheral tissue
perfusion
• Risk for infection
• Risk for bleeding

Priorities: effective respirations; adequate oxygenation; control pain

 Nursing Management
Interventions
• Close monitoring of respiratory function – note pattern, quality, effort, and pain
during respirations
• Maintain integrity of chest tube insertion site and drainage system, if present
• Provide patient comfort and support
• Facilitate breathing exercises with splinting of injured site, if necessary
• Educate patient about the status of his/her condition and the course of
treatment to be implemented
• Oxygen therapy
• Administer medications as ordered

Priorities: effective respirations; adequate oxygenation; control pain

An overview on Chest Injuries
https://youtu.be/qe-WYYJpBmI
References

Hinkle, J. & Cheever, K. (2018). Brunner and Suddarth’s textbook

of medical-surgical nursing (14th ed.). Wolters Kluwer.

Herdman, T.H. & Kamitsuru, S. (2018). NANDA International, Inc.

nursing diagnoses: Definitions and classification 2018-2020
(11th ed.). Thieme.
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