Pulmonary contusionMANAGEMENT

RESPIRATORY PRESENTATIONS · 12 SECTIONS

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445 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Acute bronchitis Acute Respiratory Distress Syndrome (ARDS)Acute respiratory failure Apparent Life-Threatening Event (ALTE-BRUE)Aspiration pneumonia Asthma exacerbation Bacterial Tracheitis Bronchiolitis Bronchiolitis (RSV)Chylothorax Community-acquired pneumonia COPD exacerbation COVID-19 pneumonia Croup Croup (laryngotracheobronchitis)Cystic Fibrosis Exacerbation Empyema Epiglottitis Epiglottitis (Pediatric)Fat Embolism Syndrome Foreign Body Aspiration Foreign Body Aspiration (Pediatric)Healthcare-Associated Pneumonia Hemothorax Hospital-acquired pneumonia Legionnaires' Disease Lung Abscess Pertussis Pleural effusion Pleurisy Pneumocystis jirovecii Pneumonia Pneumocystis Pneumonia Pneumomediastinum Pneumothorax (Simple)Pneumothorax (traumatic)Psittacosis Pulmonary Alveolar Proteinosis Pulmonary contusion Pulmonary Edema (Non-cardiogenic)Sarcoidosis Exacerbation Smoke Inhalation Injury Spontaneous pneumothorax Status Asthmaticus Sudden Infant Death Syndrome (SIDS)Tension Pneumothorax Tracheal Stenosis Viral Pneumonia

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp36

Immediate priorities

›Stabilization and early threats

›Airway protection triggers

›GCS < 8

›Refractory hypoxemia despite high-flow oxygen

›Severe work of breathing

›Inability to clear secretions

›Breathing targets

›SpO2 92% to 96%

›PaO2 10.7 to 13.3 kPa (80 to 100 mmHg) when ventilated

›Avoid hyperoxia in COPD risk

›Circulation priorities

›Hemorrhage control and permissive hypotension principles until bleeding controlled

›Avoid unnecessary crystalloid boluses in isolated lung injury

›Early imaging pathway

›Chest X-ray for screening

›CT chest when significant mechanism or worsening oxygenation

›Immediate complication screen

›Pneumothorax

›Hemothorax

›Flail chest

›Major thoracic vascular injury

›Cardiac contusion

›Aspiration

Key decision points

›Escalation triggers

›Rapidly increasing oxygen requirement within 6 to 24 hours

›Evolving contusion pattern

›Occult pneumothorax progression

›Hypotension with new hypoxemia

›Tension pneumothorax consideration

›Massive hemothorax consideration

›Hemoptysis with respiratory decline

›Tracheobronchial injury consideration

›Pulmonary laceration consideration

›Fever and purulent secretions after 48 hours

›Ventilator-associated pneumonia consideration

›Aspiration pneumonia consideration

02History/hx32

Mechanism and symptom profile

›Presentation pattern

›Blunt thoracic trauma timing

›Immediate dyspnea

›Delayed hypoxemia 6 to 24 hours

›Symptoms

›Dyspnea

›Pleuritic chest pain

›Cough

›Hemoptysis

›Functional status

›Baseline exercise tolerance

›Home oxygen use

Risk and co-injury elements

›Risk modifiers

›High-energy mechanism

›High-speed MVC

›Pedestrian struck

›Fall from height

›Thoracic cage injury indicators

›Rib fracture history

›Seatbelt sign

›Pulmonary vulnerability

›COPD

›Asthma

›Interstitial lung disease

›Smoking or vaping exposure

›Bleeding risk

›Anticoagulant use

›Antiplatelet use

›Aspiration risk

›Altered mental status

›Vomiting at scene

›Intoxication

03Physical Exam/exam33

Respiratory and thoracic exam

›Chest and respiratory findings

›Work of breathing

›Tachypnea

›Accessory muscle use

›Paradoxical movement

›Oxygenation and ventilation

›SpO2 trend

›Cyanosis

›End-tidal CO2 if available

›Auscultation and percussion

›Crackles over injured area

›Decreased breath sounds

›Dullness suggesting hemothorax

›Hyperresonance suggesting pneumothorax

›Chest wall assessment

›Point tenderness

›Crepitus

›Subcutaneous emphysema

›Flail segment

Shock and associated injury screen

›System threats

›Hemodynamic status

›Persistent tachycardia

›Narrow pulse pressure

›Hypotension after analgesia consideration

›Neurologic status

›GCS trend

›Agitation from hypoxemia

›Abdominal and pelvic injury clues

›Abdominal tenderness

›Seatbelt sign extension

›Extremity trauma burden

›Long bone fractures

›Major soft tissue injury

04Differential Diagnosis/ddx32

Life-threatening thoracic causes of hypoxemia after trauma

›Immediate threats

›Tension pneumothorax (J93.0)

›Sudden deterioration

›Unilateral absent breath sounds

›Massive hemothorax (J94.2)

›Shock

›Dullness to percussion

›Tracheobronchial injury (S27.4)

›Persistent large air leak

›Subcutaneous emphysema

›Cardiac tamponade (I31.4)

›Hypotension

›JVP elevation when assessable

›Blunt cardiac injury (S26.9)

›Dysrhythmia

›Troponin elevation pattern

Mimics and complications

›Alternative or coexisting causes

›Aspiration pneumonitis (J69.0)

›Witnessed emesis

›Dependent infiltrates

›Pneumonia (J18.9)

›Fever after 48 hours

›Focal consolidation

›Pulmonary embolism (I26.99)

›Disproportionate hypoxemia

›Pleuritic pain without imaging correlate

›ARDS (J80)

›Bilateral opacities

›PaO2 to FiO2 decline

›Pulmonary laceration (S27.3)

›Traumatic pneumatoceles

›Hemoptysis

05Laboratory Tests/lt28

Core labs and trend markers

›Baseline and monitoring labs

›Complete blood count for anemia and leukocytosis context

›Hemoglobin trend for occult bleeding

›Leukocytosis nonspecific in early trauma

›Electrolytes and renal function for ventilation and medication planning

›Potassium for dysrhythmia risk

›Creatinine for contrast planning

›Coagulation profile for bleeding risk and procedures

›INR

›aPTT

›Lactate for shock and resuscitation adequacy

›Persistent elevation suggesting ongoing hypoperfusion

›Clearance trend for response

Gas exchange assessment

›Arterial or venous gas use

›ABG for oxygenation failure or ventilation planning

›PaO2 in mmHg

›PaCO2 in mmHg

›pH

›PaO2 to FiO2 ratio for severity stratification

›Correlation with respiratory support needs

›Trend over first 24 hours

Targeted tests for co-injuries

›Co-injury evaluation

›Type and screen for significant mechanism or bleeding concern

›Transfusion readiness

›Massive transfusion pathway alignment

›Troponin and ECG correlation when blunt cardiac injury concern

›Isolated troponin without ECG changes interpretation caution

›Serial trend if initial abnormal

06Diagnostic Tests/dt50

Scoring Systems

›Severity framing tools

›PaO2 to FiO2 ratio

›Mild impairment 200 to 300

›Moderate impairment 100 to 200

›Severe impairment < 100

›Berlin ARDS framework for trauma-associated lung injury

›Timing within 1 week of known insult

›Bilateral opacities on imaging

›Respiratory failure not fully explained by cardiac failure or fluid overload

›PEEP or CPAP at least 5 cm H2O when classifying

›Injury Severity Score context for multisystem trauma

›Higher ISS association with respiratory complications

›Disposition planning support

MRI

›Limited role

›Non-routine imaging modality

›Poor feasibility in unstable trauma

›Limited incremental benefit over CT for contusion

›Select scenarios

›Radiation avoidance with stable patient and diagnostic uncertainty

›Research or specialty consult driven protocols

›CT chest characterization

›Diagnostic performance

›Higher sensitivity than chest X-ray for contusion detection

›Earlier detection prior to radiographic evolution on X-ray

›Typical CT findings

›Non-segmental ground-glass opacities

›Patchy consolidation not respecting lobar boundaries

›Adjacent to area of impact

›Complication detection

›Pneumothorax

›Hemothorax

›Pulmonary laceration

›Rib fractures and flail segments

›Management impact considerations

›Contusion volume correlation with ventilation requirement risk

›Co-injury discovery driving admission level

Ultrasound

›Point-of-care applications

›Lung ultrasound patterns

›Focal B-lines near area of injury

›Subpleural consolidations

›Pleural line abnormalities

›Pneumothorax exclusion or detection

›Lung sliding presence

›Lung point identification when present

›Pleural fluid assessment

›Hemothorax screening

›Guidance for thoracentesis or chest tube planning

›Cardiac and volume status integration

›Pericardial effusion screening in trauma

›IVC assessment as adjunct only

07Disposition/dispo28

Level of care selection

›Admission stratification

›ICU indications

›Need for invasive mechanical ventilation

›Need for noninvasive ventilation with high support

›PaO2 to FiO2 ratio < 200 with progression

›Hemodynamic instability or ongoing transfusion need

›Significant associated injuries requiring ICU monitoring

›Step-down or monitored bed indications

›Supplemental oxygen requirement with stable trend

›Multiple rib fractures with high analgesia needs

›Elderly with moderate contusion burden

›Ward admission considerations

›Minimal oxygen requirement

›Reliable pain control and incentive spirometry performance

›Stable imaging and vitals over observation window

Discharge criteria

›Discharge suitability

›No oxygen requirement at rest and ambulation

›Stable SpO2 92% or higher on room air

›No increasing respiratory rate trend

›Pain controlled on oral regimen

›Effective cough and deep breathing

›Incentive spirometry participation

›No concerning associated injuries

›No pneumothorax needing intervention

›No uncontrolled bleeding risk

›Follow-up plan and return precautions documented

›Primary care or trauma clinic follow-up

›Clear red flags provided

08Treatment/t103

Oxygenation and ventilation strategy

›Respiratory support escalation

›Supplemental oxygen modalities

›Nasal cannula

›Flow titration to SpO2 target

›Humidification if higher flows

›Face mask and non-rebreather

›Bridge to definitive therapy if escalating needs

›Continuous SpO2 monitoring

›High-flow nasal cannula

›Hypoxemia with preserved ventilation

›Close monitoring for fatigue

›Noninvasive ventilation

›CPAP for oxygenation failure without contraindications

›Initial CPAP 5 to 10 cm H2O

›Titration to oxygenation and comfort

›BiPAP for combined oxygenation and ventilation support

›Contraindications

›Hemodynamic instability

›Inability to protect airway

›Facial trauma preventing seal

›Intubation and invasive ventilation

›Indications

›Refractory hypoxemia

›Rising PaCO2 with fatigue

›Airway protection requirement

›Lung-protective ventilation

›Tidal volume 6 mL per kg predicted body weight

›Plateau pressure target < 30 cm H2O

›Driving pressure minimization strategy

›PEEP strategy

›Minimum 5 cm H2O

›Higher PEEP when recruitable lung and oxygenation failure

›Oxygen targets

›PaO2 10.7 to 13.3 kPa (80 to 100 mmHg)

›SpO2 92% to 96%

›Adjuncts for severe hypoxemia

›Prone positioning for PaO2 to FiO2 < 150 with ARDS physiology

›Early initiation within 24 to 48 hours when criteria met

›Team and pressure injury precautions

›Neuromuscular blockade for ventilator dyssynchrony

›Short course consideration in severe ARDS

›Deep sedation and monitoring requirements

Analgesia and pulmonary hygiene

›Pain control as respiratory therapy

›Multimodal analgesia

›Paracetamol 1 g PO or IV every 6 hours

›Maximum 4 g per day

›Lower maximum in liver disease or low body mass

›Ibuprofen 400 mg PO every 6 to 8 hours when no contraindication

›Renal risk and bleeding risk consideration

›Avoid in significant renal injury or high bleeding risk

›Opioid analgesia for moderate to severe pain

›Fentanyl IV 25 to 50 micrograms

›Repeat every 5 to 10 minutes to effect

›Monitoring for hypoventilation

›Hydromorphone IV 0.2 to 0.4 mg

›Repeat every 10 to 15 minutes to effect

›Caution in elderly and renal impairment

›Regional techniques when available

›Thoracic epidural for severe rib fracture pain

›Improved ventilation mechanics potential

›Contraindications

›Coagulopathy

›Spine injury concern

›Erector spinae plane block or paravertebral block

›Alternative when epidural not feasible

›Ultrasound-guided local protocols per service

›Pulmonary hygiene bundle

›Incentive spirometry

›Hourly while awake

›Documented volumes and trend

›Early mobilization when safe

›Upright positioning

›Assisted ambulation

›Secretion management

›Chest physiotherapy when indicated

›Suctioning when unable to clear secretions

Fluids, transfusion, and hemodynamics

›Lung-friendly resuscitation

›Fluid strategy

›Avoid liberal crystalloid in isolated contusion

›Balanced crystalloids in small boluses for clear hypovolemia

›Blood product strategy when hemorrhage present

›Massive transfusion protocol activation criteria per trauma system

›Hemoglobin trend integration with imaging and exam

›Vasopressors when needed after adequate volume assessment

›Norepinephrine infusion initiation for persistent hypotension

›Starting 0.02 to 0.05 micrograms per kg per minute

›Titration to MAP target per patient context

Medications and complication prevention

›Infection and thrombosis considerations

›Antibiotics

›Not routine for uncomplicated pulmonary contusion

›Indications

›Clinical pneumonia

›Aspiration with infection features after observation

›Venous thromboembolism prophylaxis

›Enoxaparin 30 mg SC every 12 hours when no contraindication

›Timing coordinated with bleeding risk and procedures

›Renal dosing adjustment as needed

›Mechanical prophylaxis when pharmacologic contraindicated

›Intermittent pneumatic compression

›Early mobilization

›Stress ulcer prophylaxis in ventilated ICU patients per unit protocol

›Risk based selection

›Reassessment for de-escalation

09Special Populations/sp40

Pregnancy

›Pregnancy-specific considerations

›Maternal oxygenation priority

›Higher oxygen reserve needs for fetal oxygen delivery

›Lower threshold for escalation in sustained hypoxemia

›Imaging strategy

›Chest X-ray acceptable with shielding when needed

›CT chest when benefits outweigh risks for major trauma evaluation

›Analgesia considerations

›Paracetamol preferred baseline agent

›NSAID avoidance in later gestation consideration

›Fetal assessment triggers

›Viable gestation with significant trauma

›Obstetric consultation for monitoring plan

Geriatric

›Older adult risks

›Lower physiologic reserve

›Early fatigue and respiratory failure risk

›Higher pneumonia risk

›Medication sensitivity

›Opioid dose reduction and slower titration

›Delirium risk with sedatives

›Disposition bias toward admission

›Lower threshold for monitored bed

›Early physiotherapy involvement

Pediatrics

›Pediatric adjustments

›Presentation differences

›More compliant chest wall with significant internal injury despite minimal external findings

›Rapid decompensation risk

›Oxygenation targets

›Age-appropriate respiratory rate interpretation

›SpO2 target similar unless specific chronic disease

›Analgesia weight-based

›Paracetamol 15 mg per kg PO every 6 hours

›Maximum per local pediatric guidance

›Dosing reconciliation with all sources

›Ibuprofen 10 mg per kg PO every 6 to 8 hours when appropriate

›Contraindication screening

›Hydration status attention

›Child protection and safety considerations

›Non-accidental trauma consideration when history inconsistent

›Social work involvement triggers

10Background/b30

Epidemiology

›Frequency and association patterns

›Common blunt chest trauma injury

›Often coexists with rib fractures

›Often coexists with pneumothorax or hemothorax

›Time course relevance

›Worsening gas exchange can peak within 24 to 48 hours

›Complication risk increases with contusion burden and age

Pathophysiology

›Injury mechanisms

›Alveolar hemorrhage and interstitial edema

›VQ mismatch and shunt physiology

›Decreased lung compliance

›Inflammatory cascade contribution

›Secondary injury progression over hours

›ARDS risk in severe cases

›Mechanical factors

›Pain splinting leading to atelectasis

›Impaired secretion clearance leading to pneumonia

Therapeutic Considerations

›Treatment principles and rationale

›Supportive care as mainstay

›Oxygenation support until edema resolves

›Ventilation support when fatigue or shunt severe

›Lung-protective ventilation importance

›Minimizes ventilator-induced lung injury risk

›Improves outcomes in ARDS physiology

›Conservative fluid strategy

›Reduces pulmonary edema burden

›Balances perfusion needs against lung injury

›Analgesia as disease-modifying support

›Improves tidal volume and cough effectiveness

›Reduces atelectasis and secretion retention

11Patient Discharge Instructions/pdi20

Copy discharge instructions

›Discharge instructions

›Diagnosis explanation

›Lung bruise after chest injury

›Breathing can worsen over the next 1 to 2 days

›Home care

›Deep breathing and coughing every hour while awake

›Incentive spirometer use if provided

›Walk and sit upright often

›Pain medicines as prescribed

›Return to ED now

›Increasing shortness of breath

›New chest pain not controlled with medicines

›Fainting or severe dizziness

›Lips or face turning blue

›Coughing up increasing blood

›Fever or shaking chills

›Confusion or extreme sleepiness

›Follow-up

›Primary care or trauma follow-up within 24 to 72 hours if ongoing symptoms

›Earlier follow-up if oxygen used at home or worsening pain

12References/r13

Guidelines and evidence sources

›Core sources

›ATLS principles for initial trauma assessment and thoracic injury management

›Trauma society guidance for blunt chest trauma supportive care and ventilation strategies

›ARDS lung-protective ventilation evidence base and Berlin definition framework

›Coding and terminology

›ICD-10 lung contusion and laceration codes

›Contusion of lung, unilateral (S27.321A, S27.322A)

›Contusion of lung, bilateral (S27.323A)

›SNOMED CT concept alignment

›Pulmonary contusion (disorder)

›Blunt chest trauma (event)

›Build instruction source

›Clinical management system specification

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Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

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