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 NBME ,1, Think with me plz  

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A 4-year-old boy is brought to the emergency department 20 minutes after being involved in a motor vehicle collision. He was an unrestrained passenger. On arrival, his blood pressure is 110/70 mm Hg, pulse is 100/min, and respirations are 32/min with grunting and retractions. Examination shows multiple bruises over the chest. Arterial blood gas analysis while breathing 40% oxygen shows:

pH 7.38
PCO2 34 mm Hg
PO2 66 mm Hg

An x-ray film of the chest obtained 4 hours later shows diffuse infiltrates on the right side. Which of the following is the most likely diagnosis?

) Acute respiratory distress syndrome

) Aspiration pneumonia

) Fat embolism

) Hemothorax

) Pulmonary contusion






ite e pulmonary contusion Big Time



Pulmonary contusion

X-Ray normal?
Opacities on x-ray may take an hour or more to appear, making HYPOXIA a better indicator of contusion immediately following trauma.

What is the cause of hypoxia due to pulmonary contusion?
Ventilation-Perfusion mismatch from:
• Interstitial hemorrhage
• Leakage of fluids (blood/plasma) into alveoli
• Alveolar collapse

What other condition is similar to this?
ARDS Adult respiratory distress syndrome, which is loss of integrity to alveolar-capillary barrier

How are patients with pulmonary contusion treated?
Analgesics, pulmonary toilet, and intensive care unit (ICU) monitoring for 24 hours. Intubation if respiratory distress

Deja Review Surgery, 2nd Edition.

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