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Pulmonary Contussion

- See: Cardiac Contussion: 
- primary complication is comprimised oxygenation; 
- due to intersitial hemorrhage with alveolar collapse and alveolar flooding 
- shunting, results in hypoxia that is relatively refractory to enhanced inspiratory oxygen concentration; 
- pulmonary contusions are usually quite localized; 
- Management: 
- PEEP and continuous positive airway pressure  
- over-agressive diuresis or extreme hypovolemia can decrease cardiac output and exacerbate hypoxemia already present due to intrapulmonary shunting associated with pulmonary contusssion; 
- the decision not to intubate should be based on: 
- the overall stability of the of the patient 
- adequacy of oxygenation (pO2 > 60 mm on 50% O2) - respirations of > 24 / min 
- spontaneous tidal volume greater than 5 ml/kg 
- vital capacity > 10 ml/kg 
- pulmonary mechanics 
Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion--a cause of posttraumatic ARDS?