Pulmonary Contusion

GENERAL INFORMATION:

What is a pulmonary contusion? A pulmonary contusion is bruising of your lung tissue that may cause pain and trouble breathing. Your lungs are two sacs in your chest that get oxygen from the air you breathe. A pulmonary contusion is a common lung injury after a blunt (not sharp) trauma to your chest. The force of the trauma damages your lung cells, blood vessels, and other tissues. You may have fluid, such as blood, and swelling inside one or both of your lungs after the trauma. The blood and swelling in your lung forms the bruise that causes your pulmonary contusion. Treating your pulmonary contusion may resolve your breathing problems. Treatment may also resolve any chest injuries you have, and may save your life.

What causes a pulmonary contusion? A pulmonary contusion may be caused by any of the following:

• Direct force: Your ribs or chest wall may be pushed into your lungs by the blunt trauma. The force of the blow to your chest may reach your lungs, making your lung tissues swell and bleed. This type of injury usually happens in motor vehicle crashes.
  
  
• Expanding gases: Forces from a blunt trauma may increase the pressure inside your lungs. The pressure may cause gas bubbles inside your alveoli (sac-like air spaces in the lung) to expand (become bigger). When they get too big, your alveoli may break open and bleed.
  
  
• Tearing forces: During blunt trauma, your heart and lungs may move and slam against your chest. This may cause damage to the blood vessels and other tissues in your chest. Blood and other fluids may then build up inside your lungs.

What are the signs and symptoms of a pulmonary contusion? You may have no signs and symptoms of a pulmonary contusion. Often, you may have one or more of the following:

• Bruises or scratches on your back or chest.
  
  
• Chest pain.
  
  
• Coughing up blood or large amounts of watery sputum (spit).
  
  
• Fast and shallow breathing.
  
  
• High-pitched wheezing (hissing sound) when breathing out.
  
  
• Trouble breathing.

What other injuries may occur with a pulmonary contusion? Strong forces from a blunt trauma may cause other chest injuries making is hard for you to breathe. You may have any of the following:

• Broken ribs: Broken rib bones may prevent your lungs from completely filling up with air when breathing in.
  
  
• Hemothorax: Hemothorax is the presence of blood in the pleural space (area between the linings of the lungs and chest).
  
  
• Lung lacerations: Lacerations are cuts in your lungs.
  
  
• Pneumothorax: A pneumothorax occurs when air becomes trapped in your pleural space causing your lung to collapse.
  
  
• Other injuries: Your spine and spinal cord, airways, large blood vessels, muscles, and your heart may also be injured.

How is a pulmonary contusion diagnosed? Your caregiver will do a complete physical examination and talk with you about your symptoms. Tell your caregiver if you were involved in any violent event that may have caused your injury. Your caregiver will check your chest area for bleeding, breaks, or punctures in your skin. He will also watch and listen to how you breathe.

• Arterial blood gases: This test is also called an ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of oxygen, acids, and carbon dioxide it contains.
  
  
• Computed tomography (CT) scan: A special x-ray machine with a computer will take pictures of your chest. The pictures will help caregivers see areas that may be bleeding, and any broken bones.
  
  
• Chest x-ray: This is a picture of your heart and lungs. Your caregiver will use the pictures to look for bruises or other injuries in your lungs. It may take up to 6 hours after your injury before a pulmonary contusion can be seen on an x-ray. Other injuries in your chest may also cover the bruise, making it hard to find.
  
  
• Ultrasound: An ultrasound is a test that looks inside of your body. Sound waves are used to show pictures of your organs and tissues on a TV-like screen. An ultrasound may show if you have fluid, swelling, or bruises in your lungs.

How is a pulmonary contusion treated? Mild pulmonary contusions normally start to heal in 2 to 3 days. A mild pulmonary contusion may completely go away within 10 to 14 days. Your treatment will depend on how severe your injury is. Caregivers will use different treatments to help you breathe easier and get enough oxygen into your body. You may need one or more of the following:

• Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. This lets your lungs fill up with air when you breathe, and helps your heart beat normally. A tube may be inserted through an incision (cut) in your chest to drain the air or fluid. The chest tube is attached to a container to collect the blood or fluid.
  
  
• Deep breathing and coughing: Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up sputum from your lungs. You can deep breathe and cough on your own, or with the help of an incentive spirometer. An incentive spirometer is a device that can help you take deeper breaths.
  
  
• Mechanical ventilation: If you cannot breathe properly, caregivers may put an endotracheal (ET) tube into your mouth and throat. The ET tube is a soft tube which keeps your trachea (windpipe) open and helps you breathe. The tube will be connected to a ventilator (breathing machine) to help you breathe and get enough oxygen.
  
  
• Non-invasive positive-pressure ventilation: Noninvasive positive-pressure ventilation, or NPPV, is a machine that will help you breathe. The machine helps your lungs fill with air by using a mask or a mouthpiece. If a mask is used, it may go over your nose and mouth, or just your nose.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose.
  
  
• Pain control: Pain in your chest may keep you from breathing deeply and filling your lungs with enough air. Pain medicines may decrease your pain making it easier for you to breathe. You will be given pain medicine as a shot or in your IV. An IV is a tube placed in your vein for giving medicine or liquids. You may also receive pain medicines through an epidural which is a small tube inserted into your back.
  
  
• Suctioning: Caregivers may insert a tube connected to a suction machine into your mouth, nasal passages, or ET tube. Suctioning is done to remove any blood or mucus that is blocking your air passages.

When should I call my caregiver? Call your caregiver if:

• You have a fever.
  
  
• You have questions or concerns about your condition or treatment.

When should I seek immediate help? Seek care immediately or call 911 if:

• You cough up blood.
  
  
• You feel dizzy or light-headed, or have passed out.
  
  
• You have trouble breathing.
  
  
• You have a heavy or squeezing feeling in your chest that lasts more than a few minutes.
  
  
• You have pain that starts in your chest then spreads to your shoulders, neck, or arms.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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