severe traumatic hemothorax

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severe traumatic hemothorax

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17 Posts

M.A.S
Forum Senior

Topics: 28
Posts: 56

06/06/04 - 12:02 PM

A 27 y/o man is now undergoing drainage of blood
through tube thoracostomy. He has severe hemothorax as
a result of traffic accident. What is the NEXT STEP in
managment?

a. to check the vital signs
b. to monitor blood drainage rate
c. blood transfusion
d. all of the above are indicated as the next step

tess
Forum Guru

Topics: 131
Posts: 368

06/06/04 - 07:39 PM

Both a and b look right, b may be better than a. Just guessing. Please don't forget to give answer. Thanks. :lol:

M.A.S
Forum Senior

Topics: 28
Posts: 56

06/07/04 - 01:35 AM

This is a question in our surgery exam. Indeed i don't know the right answer, but my choice was "all of the above" because also blood transfusion is indicated in severe traumatic hemothorax. If i'm wrong please correct me, Thanks.

asmi
Forum Hero

Topics: 1043
Posts: 4,609

06/09/04 - 07:13 PM

i think D is the best choice .

tess
Forum Guru

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Posts: 368

06/11/04 - 01:50 PM

asmi, why transfusion is also indicated? even with not a quite a mount of hemothorax? :roll:

thanks!

Ouli Maty
Forum Elite

Topics: 33
Posts: 275

06/11/04 - 06:26 PM

I will go with b because, it is the one that would make you change the management from observation to surgery to stop the bleeding of a systemic artery probably.
Tranfusion in severe hemothorax that is still bleeding would be like purring in one end and getting it in the other.
The patient has sustain a trauma severe enough to cause a hemothorax, it is obvious that you will check his vitals but he could be bleeding from somewhere else. I mean if the vitals are not good you cannot blame it all on the hemothorax.
I might be 180 degres wrong but I will learn from it.

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mkodumagulla
Forum Senior

Topics: 12
Posts: 99

06/15/04 - 06:53 AM

I would go with a. Because checking the vitals gives the genaral information of the pt's condition. Checking the blood drainage does not seem to be correct.Correct me if wrong.

drkjigs
Forum Senior

Topics: 28
Posts: 146

06/15/04 - 09:23 AM

it is b as ATLS says.. to check vitals after each step. But perrtaining to the haemothorax the amount of blood & the rate of filling the bottle will decide the next management. eg. if it is a massive haemo of 1500 mls on ICD insertion then proceed to thoracotomy as a deifinitive mamangement along with fluid resucitation..crystalloids via 2 IV cannulae & then type specific bld. The next state that determines thoracotomy or conservative management would be patient vitals & continuing rate of bleed of =/>200mls of frank bld per hour for 2-4 hrs. At the same time keep filling the pt with fluids & bld.
In practical situation... being a trauma trainee... depending on pts age..one decides. if it is a young chap with a good reserve..take a chance with intermittent clamping the tube to tamponade the bleed along with lung inflation via endotracheal venti is the commonest tried option before chop chop. In the old.... depending on survival chances due to associated injuries.. if going to theatre then thoracotomy is advisable.. if not then watchful observation on vitals after the initial bleed measurement will determine surgical intervention.
As regards bld transfusion... agree it is important.. but the NEXT step would only be to begin with crystallids in the ration of 1:3

Hope this helps...correct me if wrong

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tess
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Topics: 131
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06/15/04 - 09:42 AM

Thank you for your analysis, doc, it really helps! GL!

asmi
Forum Hero

Topics: 1043
Posts: 4,609

06/23/04 - 06:53 PM

#10

"tess" wrote:
asmi, why transfusion is also indicated? even with not a quite a mount of hemothorax? :roll:

thanks!

Tess,

I thought since its severe hemothorax(bleeding from sytemic vessles possible) BT is essential . :roll:

cool
Forum Newbie

Topics: 4
Posts: 40

07/23/04 - 01:05 AM

#11

then what is exact answer??

dmnz
Forum Junior

Topics: 7
Posts: 72

07/27/04 - 05:53 AM

#12

[B]

DMNZ :wink:

mdwannabe
Forum Guru

Topics: 37
Posts: 1,133

07/27/04 - 12:14 PM

#13

B...such monitoring will tell if patient needs to go to OR right away or not. More than 200cc per hour for 4 hours/ or 1500cc as the tube goes in..is an indication for chest surgeon to get his hands dirty.

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oddissy4u
Forum Guru

Topics: 107
Posts: 389

07/27/04 - 04:14 PM

#14

:arrow: hemothorax is clinical diagnosis in trauma setting

1st :arrow: drainage --if more thn 1000ml or more thn 600 ml in subsequent 6 hrs then :arrow: thoracotomy / if lesser thn low pressure pulmonary system close the bleeding site.

primary is bleeding site control n thn comes infusion fluids else it will be like fuids gping in from 1 site n purring out thr other...

so here answer is B.as everyone agreed :wink:

merrk
Forum Elite

Topics: 27
Posts: 280

09/09/04 - 08:41 AM

#15

What if the pt is in hypovolemic shock? Isnt it recommended to give to give IV fluids until cross-matched blood arrives and then give blood?
I think blood tranfusion is indicated but , maybe not hte next step.
Blood should be considered if there is hemorrhage and over 15% volume lost.

I'd still go for D. M.A.S. pls ask your surgery prof who made the paper for the right answer!

Thanks

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buzz
Forum Newbie

Topics: 4
Posts: 18

10/07/04 - 10:43 PM

#16

HEY DRKJIGS,

A VERY THOROUGH EVALUATION, THANKS,
BUT WOULDNT YOU CONSIDER USING COLLOIDS INSTEADS OF CRYSTALLOIDS BEFORE YOUR RULE OUT PULMONARY CONTUSION???

tuesday
Forum Senior

Topics: 7
Posts: 207

11/19/04 - 02:43 PM

#17

i agree w/ odissy4u.
& yes why not use colloid first instead of crystalloid.

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