Hemothorax



Hemothorax





Hemothorax occurs when blood enters the pleural cavity—from damaged intercostal, pleural, or mediastinal vessels (or occasionally from the lung’s parenchymal vessels). Depending on the amount of blood and the underlying cause of bleeding, hemothorax can cause varying degrees of lung collapse. About 25% of
patients with chest trauma (blunt or penetrating) experience hemothorax. Pneumothorax (air in the pleural cavity) commonly accompanies hemothorax.


Causes

Hemothorax usually results from either blunt or penetrating chest trauma. Less commonly, it occurs because of thoracic surgery, pulmonary infarction, neoplasm, dissecting thoracic aneurysm, or anticoagulant therapy.


Complications

Hemothorax may result in mediastinal shift, ventilatory compromise, lung collapse and, without successful intervention, cardiopulmonary arrest.


Assessment

The patient history typically reflects recent trauma. In addition, the patient may complain of chest pain and sudden difficulty breathing, which may be mild to severe, depending on the amount of blood in the pleural cavity.

Inspection typically discloses a patient with tachypnea, dusky skin color, diaphoresis, and hemoptysis (bloody, frothy sputum). If hemothorax progresses to respiratory failure, the patient may show restlessness, anxiety, cyanosis, and stupor. As the chest rises and falls, you may notice that the affected side may expand and stiffen; the unaffected side may rise with the patient’s gasping respirations.

Percussion may disclose dullness over the affected side of the chest; auscultation may detect decreased or absent breath sounds over the affected side, tachycardia, and hypotension.


Diagnostic tests



  • Thoracentesis performed for diagnosis and therapy may yield blood or serosanguineous fluid. Fluid specimens may be sent to the laboratory for analysis.


  • Chest X-rays display pleural fluid and detect mediastinal shift.


  • Arterial blood gas (ABG) analysis documents respiratory failure.


  • Hemoglobin levels may be decreased, depending on blood loss.


Treatment

In hemothorax, treatment aims to stabilize the patient’s condition, stop the bleeding, evacuate blood from the pleural cavity, and reexpand the affected lung. Mild hemothorax usually clears in 10 to 14 days, requiring only observation for further bleeding. In severe hemothorax, treatment includes thoracentesis to remove blood and other fluids from the pleural cavity and then insertion of a chest tube into the sixth intercostal space in the posterior axillary line. The diameter of a typical chest tube is large to prevent clots from blocking it. Suction may also be used. If the chest tube isn’t effective, the surgeon may need to perform a thoracotomy to evacuate blood and clots and control bleeding.

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Jun 17, 2016 | Posted by in NURSING | Comments Off on Hemothorax
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