Hemothorax
Hemothorax: Excerpt from Professional Guide to Diseases (Eighth Edition)
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. Pneumothorax — 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. In some cases, it results from thoracic surgery, pulmonary infarction, neoplasm, dissecting thoracic aneurysm, or a complication of tuberculosis 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 pathologic conditions. 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, whereas the unaffected side rises and falls with the patient’s breaths.
Diagnosis
Characteristic clinical signs and a history of trauma strongly suggest hemothorax. Percussion and auscultation reveal dullness and 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 reveal respiratory failure; hemoglobin may be decreased, depending on the amount of blood lost.
Treatment
Treatment is designed to stabilize the patient’s condition, stop the bleeding, evacuate blood from the pleural space, and re-expand the underlying lung. Mild hemothorax usually clears in 10 to 14 days, requiring only observation for further bleeding. In severe hemothorax, thoracentesis not only serves as a diagnostic tool but also removes 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, as ordered, to treat shock. Monitor pulse oximetry and 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.
❑ Carefully observe chest tube drainage and record the volume drained (at least every hour). Milk the chest tube (only if necessary and according to facility and physician protocols) to keep it open and free from clots. If the tube is warm and full of blood and the bloody fluid level in the water-seal bottle is rising rapidly, report this at once. The patient may need immediate surgery.
❑ Watch the patient closely for pallor and gasping respirations. Monitor his vital signs diligently. Falling blood pressure, rising pulse rate, and rising respiratory rate may indicate shock or massive bleeding.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- Hemothorax
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Chest expansion, asymmetrical (Professional Guide to Signs & Symptoms (Fifth Edition))
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