Pulmonary Contusion : definition untul treatment

Pulmonary contusion, know detail from definition until treatment

1. Pulmonary Contusion   SURGICAL SPECIALIST EDUCATION PROGRAM FACULTY OF MEDICINE, SEBELAS MARET UNIVERSITY DR. MOEWARDI REGIONAL PUBLIC HOSPITAL SURAKARTA 2025 23

2. DEFINITION Rendeki , S., & Molnár , T. F. (2019). Pulmonary contusion. Journal of thoracic disease, 11(Suppl 2), S141-S151. https://doi.org/10.21037/jtd.2018.11.53 Pulmonary contusion is a condition of injury to the lung parenchyma due to chest trauma that causes alveolar edema or hematoma and loss of physiological structure and function of the lung. Excess fluid causes hypoxia. In cases of severe injury, the inflammatory response results in ARDS. 22

3. EPIDEMIOLOGY Zhou D, Qiu J, Liang Y, dkk. Analisis epidemiologi terhadap 9.596 pasien dengan cedera paru-paru akut di Rumah Sakit Militer China. Exp Ada Med 2017; 13: 983- 8. Pulmonary contusion occurs in about 20% of blunt trauma patients. It is the most common chest injury in children. Mortality rates range from 10 to 25%, and 40-60% of patients will require mechanical ventilation. Complications of pulmonary contusion injuries include ARDS, respiratory failure, atelectasis and pneumonia. 21

4. ETIOLOGY Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. Blunt chest trauma Traffic accidents Blast or shockwave injuries associated with penetrating trauma Flail Chest Sharp trauma with bleeding mechanism and parenchymal edema 20

5. CLINICAL MANIFESTASION Zhou D, Qiu J, Liang Y, dkk. Analisis epidemiologi terhadap 9.596 pasien dengan cedera paru-paru akut di Rumah Sakit Militer China. Exp Ada Med 2017; 13: 983- 8. 19

6. PATHOPHYSIOLOGY https://www.sciencedirect.com/science/article/abs/pii/S0020138305000537 18

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8. Local Effects Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. Lacerations of the lung tissue Alveoli filled with hemorrhage Reduced lung complience resulting in reduced ventilation Increased pulmonary vascular resistance Decreased pulmonary blood flow Thickened alveolar septa with impaired diffusion Decreased alveolar diameter Vacuolation of lung tissue Delayed capillary leakage with increased BAL protein Increase in neutrophils in lung tissue 16

9. Systemic Effects Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. Increased TCC (Terminal Component Complement) Decreased complement Increased tumor necrosis factor a and interleukin 6 cytokines Decreased peritoneal macrophages, splenic macrophages and splenocytes Increased mortality due to sepsis 15

10. DIAGNOSIS Hashimoto S, Sanui M, Egi M, et al. The clinical practice guideline for the management of ARDS in Japan. J Intensive Care 2017;5:50. HISTORY TAKING Performed to determine the mechanism of injury and the patient's symptoms. In some cases, Contusio pulmo often has symptoms similar to ARDS. 14

11. DIAGNOSIS Hashimoto S, Sanui M, Egi M, et al. The clinical practice guideline for the management of ARDS in Japan. J Intensive Care 2017;5:50. PHYSICAL EXAMINATION Airway-Breathing-Circulation Vital sign Clinical Finding: Thoracic lesion Flail Chest Fracture Costae Crackles 13

12. DEFERENTIAL DIAGNOSIS Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. 12

13. RADIOGRAPHIC FEATURES Weerakkody Y, Walizai T, Bell D, et al. Pulmonary contusion. Reference article, Radiopaedia.org (Accessed on 26 Jan 2025) https://doi.org/10.53347/rID-7346 PLAIN RADIOGRAPH Initial trauma chest radiographs may be normal. On the first day after trauma, ill-defined geographic consolidations Consolidation may be faint and usually shows rapid improvement with time, usually within a few days 11

14. RADIOGRAPHIC FEATURES Weerakkody Y, Walizai T, Bell D, et al. Pulmonary contusion. Reference article, Radiopaedia.org (Accessed on 26 Jan 2025) https://doi.org/10.53347/rID-7346 CT SCAN Will show a picture of the contusion early. Computed tomography can depict lung injuries and contusions that are not visible on the initial chest X-ray. CT is easily available, highly accurate, and readily available in emergency departments, it is considered the gold standard for the diagnosis of lung contusion. 10

15. RADIOGRAPHIC FEATURES Weerakkody Y, Walizai T, Bell D, et al. Pulmonary contusion. Reference article, Radiopaedia.org (Accessed on 26 Jan 2025) https://doi.org/10.53347/rID-7346 ULTRASONOGRAPHY Lung ultrasound has been useful in bedsite imaging of various lung injuries such as pneumothorax, pulmonary edema, and pneumonia. It is useful to aid diagnosis when a chest X-ray is not performed, a CT scan is not available, or the patient is too unstable to be taken to the radiology scanning room. 09

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17. Treatment Algorithm Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. 07

18. Treatment Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. 06 The purpose of supportive therapy: Reduce shortness of breath pain relief clearance of airways preventing complications There is no specific therapy for post-traumatic respiratory failure that can significantly reduce the risk of developing ARDS. Oxygen consumption and use of positive pressure ventilation (SaO2 < 90%) Fluid resucitation Diuretics Analgesic Antibiotic

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20. Pain Management Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. 04

21. Mechanical Ventilation Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. Mechanical ventilation is required if lung contusion causes inadequate oxygenation. Positive pressure ventilation, where air is forced into the lungs, is required when oxygenation is significantly impaired. Noninvasive ventilation (NIV), continuous positive airway pressure (CPAP) and (BiPAP), can be used to improve oxygenation and treat atelectasis. 03

22. REFERENCES Rendeki , S., & Molnár , T. F. (2019). Pulmonary contusion. Journal of thoracic disease, 11(Suppl 2), S141-S151. https://doi.org/10.21037/jtd.2018.11.53 Zhou D, Qiu J, Liang Y, dkk . Analisis epidemiologi terhadap 9.596 pasien dengan cedera paru-paru akut di Rumah Sakit Militer China. Exp Ada Med 2017; 13: 983- 8. Pfeifer R, Heussen N, Michalewicz E, et al. Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J Trauma Acute Care Surg 2017;83:496-506. Hashimoto S, Sanui M, Egi M, et al. The clinical practice guideline for the management of ARDS in Japan. J Intensive Care 2017;5:50. Weerakkody Y, Walizai T, Bell D, et al. Pulmonary contusion. Reference article, Radiopaedia.org (Accessed on 26 Jan 2025) https://doi.org/10.53347/rID-7346 02

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