Hemothorax
Hemothorax: Excerpt from Handbook of Diseases
In hemothorax, blood from damaged intercostal, pleural, mediastinal and, infrequently, lung parenchymal vessels enters the pleural cavity. Depending on the amount of bleeding and the underlying cause, hemothorax may be associated with varying degrees of lung collapse and mediastinal shift. Pneumo-thorax — air in the pleural cavity — commonly accompanies hemothorax.
Causes
Hemothorax usually results from blunt or penetrating chest trauma; in fact, about 25% of patients with such trauma have hemothorax. Less commonly, it results from thoracic surgery, pulmonary infarction, neoplasm, dissecting thoracic aneurysm, or anticoagulant therapy.
Signs and symptoms
The patient with hemothorax may experience chest pain, tachypnea, and mild to severe dyspnea, depending on the amount of blood in the pleural cavity and associated pathology. If respiratory failure results, the patient may appear anxious, restless, possibly stuporous, and cyanotic; marked blood loss produces hypotension and shock.
The affected side of the chest expands and stiffens and the unaffected side rises and falls with the patient’s gasping respirations.
Diagnosis
The following clinical test results, along with a history of trauma, strongly suggest hemothorax:
❑ Percussion reveals dullness and, on auscultation, decreased to absent breath sounds over the affected side.
❑ Thoracentesis yields blood or serosanguineous fluid.
❑ Chest X-rays show pleural fluid with or without mediastinal shift.
❑ Arterial blood gas (ABG) analysis may document respiratory failure.
❑ Hemoglobin level may be decreased, depending on blood loss.
Treatment
Effective treatment stabilizes the patient’s condition, stops the bleeding, evacuates blood from the pleural space, and reexpands the underlying lung. Mild hemothorax usually clears rapidly in 10 to 14 days, requiring only observation for further bleeding.
In severe hemothorax, thoracentesis serves not only as a diagnostic tool but also as a method of removing fluid from the pleural cavity.
After the diagnosis is confirmed, a chest tube is inserted into the sixth intercostal space at the posterior axillary line. Suction may be used; a large-bore tube is used to prevent clot blockage. If the chest tube doesn’t improve the patient’s condition, he may need a thoracotomy to evacuate blood and clots and to control bleeding.
Special considerations
❑ Give oxygen by face mask or nasal cannula.
❑ Give I.V. fluids and blood transfusions (monitored by a central venous pressure line), as needed, to treat shock. Monitor ABG levels often.
❑ Explain all procedures to the patient to allay his fears. Assist with thoracentesis. Warn the patient not to cough during this procedure.
❑ Observe chest tube drainage carefully, and record the volume drained at least every hour. Keep the chest tube open and free from clots.
❑ Watch the patient closely for pallor and gasping respirations. Monitor his vital signs diligently. Falling blood pressure and rising pulse and respiratory rates may indicate shock or massive bleeding.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- Hemothorax
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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Chest expansion, asymmetrical (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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