Lung Contusion

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Key components in the management of lung contusion consist of 2 major principles:
1) Early good lung recruitment
2) Effective low volume resuscitation (Euvolemia)

A low volume resuscitation and not fluid restriction while keeping a good mean airway pressure is of the essence. The need for the Lasix is to remove the iatrogenic unnecessary crystalloid used that was not needed.

My 2 cents

Juan C Duchesne M.D., FACS, FCCP
Trauma and Critical Care Surgery Section
Medical Director Surgical Hospital Center
Medical Director Surgical Intensive Care Unit  
Louisiana ATLS / PHTLS State Faculty
 

 
Tulane University School of Medicine
1430 Tulane Ave., SL-22
New Orleans LA 70112-2699
Tel. 504-988-5111
Fax. 504-988-3683
 
 
 
 



-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Karim Brohi
Sent: Thursday, January 29, 2009 9:35 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Lung Contusion

While I would agree with minimizing crystalloids and maintaining euvolaemia
I don't think there's any evidence to support fluid restriction in these
patients.  A normal enteral fluid requirement should be adequate.  No
diuretics.
Karim


On 01/29/2009, KMATTOX at aol.com <KMATTOX at aol.com> wrote:
>
> You are correct.   Lasix is probably contraindicated in
> pulmonary  contusion.
>   We would use fluid RESTRICTION to even almost no  crystalloid fluid at
> all.    AVOID ALBUMIN at all  cost.    ONE doctor, not a team of multiple
> consultants writing  orders
>
> k
>
>
>
> In a message dated 1/28/2009 8:32:21 P.M. Central Standard Time,
> errington at erringtonthompson.com writes:
>
> As a  rule we don't use Lasix in pulmonary contusions.  The goal in
> caring  for patients with pulmonary contusions is
> euvolemia.  Intubate  early
> if necessary. Head of the bed should be elevated.  No  prophylactic
> antibiotics.  Early tracheostomy.
>
> Guys, am I missing  anything?
>
>
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