Patients with pulmonary contusions are at high risk for respiratory distress and pneumonia. Methods should be implemented early on in the course of treatment to improve oxygenation and ventilation. The goal of treatment should focus on re-expansion of the actelactic regions through high PEEP. Ventilation strategies should include:
Low Tidal Volume: (4-8mL/kg)
Limited plateau pressure <30mmHg
FiO2 level as low as possible to obtain SaO2 >90%
Optimal PEEP, incrementally added
Avoidance of hypovolaemia in trauma is a cornerstone of management. A balanced approach to fluid replacement is important, especially in establishing early treatment goals.14 Resuscitation goals:
The main goal of blood volume resuscitation in trauma is to preserve vital organ perfusion until bleeding can be controlled.
In immediate trauma care aim for a blood pressure greater than 90 mmHg systolic or a shock index less than 1 (HR/SBP).
Blood pressure goals for penetrating chest trauma or uncontrollable haemorrhage are generally lower than for blunt trauma in the absence of a major head injury. (SBP values less than 90 mmHg may be acceptable if cerebral perfusion is maintained).15
Tissue perfusion can be assessed in a number of ways. These include:
Skin color- pale and peripherally shut down versus mottled and blue.