While a stable pulmonary contusion may not require any specific therapy, patients are at high risk of deteriorating respiratory status and therefore require an expedited evaluation In addition, the presence of such an injury indicates that sufficient force was applied to the thorax to warrant thorough evaluation for additional injuries Clinical Assessment Initial assessment should focus on assessing and stabilizing the airway, breathing, and circulation, as well as the identification of other associated injuries Vital sign abnormalities seen with moderate to severe pulmonary contusions may include tachypnea and hypoxemia due to shunting within the lung Patients may complain of chest pain or shortness of breath, and physical examination may reveal chest wall bruising and tenderness, with focally diminished breath sounds in the affected lung These latter findings are nonspecific, however, and their absence should not be used to rule out pulmonary contusion without imaging FIGURE 115.4 Right lower lobe pulmonary contusion in a patient with associated rib fractures Subcutaneous air is also noted in the adjacent soft tissue Management