Haemothorax (Massive)

DEFINITION
Accumulation of blood in the chest cavity as a result of trauma, impairing lung function.

If >1500ml evacuated, early thoracotomy.

OR >200ml/hr for 4 hrs.

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EPIDEMIOLOGY
Seen in chest trauma.
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AETIOLOGY
Trauma.
'Massive' if >1.5L of blood accumulating in the chest cavity.
- usually after penetrating wounds to systemic or hilar vessels
- may occur in blunt trauma

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BIOLOGICAL BEHAVIOUR

Pathophysiology
Blood loss is complicated by hypoxia.


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MANIFESTATIONS

Symptoms

Shock.

Signs
Observe
Neck veins may be flat due to severe hypovolaemia
- though beware: may be distended if also a tension pneumothorax, or sometimes from the haemothorax itself shifting the mediastinum.
Percuss
Dull
Auscultate
Decreased BS.
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INVESTIGATIONS

Clinical and imaging evidence
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MANAGEMENT

Simultaneously:

1. Resuscitation of blood volume.
Large IV lines
Rapid crystalloid infusion
Type-specific blood ASAP.
Volume of blood released and rate of ongoing loss are important factors to guide fluid requirements
- colour of the blood is a poor indicator.

2. Decompression of the chest cavity.
If autotransfusion available, collect the chest blood in such a device.
Insert the chest tube (34+ French).

Early thoracotomy if
>1500ml evacuated, early thoracotomy.
OR >200ml/hr for 4 hrs.


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REFERENCES
ATLS