Made up Case:
70 yo ESRD (LUE fistua, MWF, last yesterday), HTN, DM, severe COPD presents peds struck by semi:
Airway, Breathing, Circulation initially intact, IV/O2/Monitor placed
102, 150/60, 28, 93% on RA
Secondary survey neg except for pan-right sided pain.
CXR/pelvis X-Ray unremarkable.
Pan-Scan (come on, 70 and hit by a semi, who wouldn’t pan-scan him?) shows entire right lung white out! Rest of scan is unremarkable
Diagnosis?Pneumonia…Kidding. It’s a Pulmonary Contusion!
What's the white stuff?
edema and hemorrhage (but no large lung lacerations)
What do you NOT want to do?
Give fluids to a cardiovascularly stable old man with a pulmonary contusion. Fluids can actually worsen the disease including causing edema to the other, uninjured lung! There are probably many other things you do not want to do, sorry for the “read my mind” question.
Dispo/Treatment?
1. Maintain Oxygenation, which, in a 70 year old with an entire lung out and severe COPD…very likely will require intubation. Very high risk for ARDS.
2. In the meantime, incentive spirometer and pain control to prevent atelectasis.
3. Admit to surgery, likely SICU.
By Dr. Andrew Grock and Dr. Sally Bogoch
References
Tintinalli’s 7th ed.chpt 258
The following two tabs change content below.
andygrock
Latest posts by andygrock (see all)
- Levamisole Toxicity - May 26, 2015
- Of Course, US Only for Kidney Stones… - May 18, 2015
- Case of the Month 11: Answer - May 12, 2015
0 Comments