There are two “subtle” causes of hypoxia in blunt trauma – (a) pneumothorax (and to a lesser extent, hemothorax) and (b) pulmonary contusion. The not-so-subtle causes are (1) patient is not breathing (usually from shock or head trauma) and (2) pt’s chest wall is destroyed (e.g. flail chest).
The patient had pulmonary contusion. Treatment is supplementary oxygen. Elderly / debilitated patients are prone to respiratory failure from pulmonary contusions. Younger patients tolerate pulmonary contusion surprisingly well at times despite wide-spread contusion.
When you look at the terrible chest ct, it’s really amazing how well pts tolerate these injuries.
