Hemothorax is a collection of blood in the space between the chest wall and the lung (the
pleural cavity).
The most common cause of hemothorax is chest trauma. It can also occur in patients who have:
A defect of blood clotting
Blunt trauma to the chest
Death of lung tissue (pulmonary infarction)
Lung or pleural cancercancer
Penetrating chest trauma (when a weapon such as a knife or bullet cuts the lung)
Placement of a central venous catheter
Thoracic or heart surgery
Tuberculosis
Symptoms
Anxiety
Chest pain
Rapid heart rate
Restlessness
Shortness of breath
Diagnostic exams:
Chest x-ray
o Will reveal the presence of air/blood in the pleural space on the affected site,
size and any shift in the mediastinum
ABG values
o Hypoxemia may be accompanied by hypercarbia with resultant respiratory
acidosis. Arterial 02 sat may be decrease initially but usually returns to normal
within 24 hours
Oximetry
o Will reveal o2 sat.
CBC
o Decrease hgb proportionate to the amount of blood lost in a hemothorax.
Collaborative management
Oxygen therapy
o Administered when ABG values oximetry demonstrates the presence of
hypoxemia.
Thorancentesis
o Removal of blood in the pleural space
Chest tube placement
o During insertion upright position so that lung falls away from the chest rales.
Thoracostomy
o Instillation of a sclerosing agent (tetracycline, 50% glucose solution) into the
pleural cavity to produce adhesion and a line of fusion between the visceral and
parietal pleural layers.
IV therapy
o For loss of fluid or blood.
Anatomy and physiology
Trachea
o Or windpipe
o A flexible, muscular, 12 cm long air passage with c-shaped cartilaginous rings.
Bronchi and bronchioles
o a passage of airway in the respiratory tract that conducts air into the lungs.
Lungs
o Respiration organ
o to transport oxygen from the atmosphere into the bloodstream, and to release
carbon dioxide from the bloodstream into the atmosphere.
Alveoli
o respiratory sites of gas exchange with the blood.
Thorax
o the region of the body formed by the sternum, the thoracic vertebrae and the
ribs. It extends from the neck to the diaphragm, and does not include the upper
limbs. The heart and the lungs reside in the thoracic cavity, as well as many
blood vessels. The inner organs are protected by the rib cage and the sternum.
Pleurae
o a serous membrane which folds back onto itself to form a two-layered,
membrane structure.
o The thin space between the two pleural layers is known as the pleural cavity; it
normally contains a small amount of pleural fluid.
o The outer pleura (parietal pleura) is attached to the chest wall.
o The inner pleura (visceral pleura) covers the lungs and adjoining structures, viz.
blood vessels, bronchi and nerves.
o aids optimal functioning of the lungs during respiration.
o also contains pleural fluid, which allows the pleurae to slide effortlessly against
each other during ventilation.
o pleural cavity transmits movements of the chest wall to the lungs, particularly
during heavy breathing. This occurs because the closely opposed chest wall
transmits pressures to the visceral pleural surface and hence to the lung itself.
Incidence
In a 34-month period at a large level-one trauma center, 2086 children younger than 15 years
were admitted with blunt or penetrating trauma; 104 (4.4%) had thoracic trauma.Of the
patients with thoracic trauma, 15 had hemopneumothorax (26.7% mortality rate), and 14 had
hemothorax (57.1% mortality rate). Many of these patients had other severe extrathoracic
injuries. Nontraumatic hemothorax carries a much lower mortality rate.
In another series of children with penetrating chest injuries (ie, stab or gunshot wounds), the
morbidity rate was 8.51% (8 of 94).Complications included atelectasis (3), intrathoracic
hematoma (3), wound infection (3), pneumonia (2), air leak for more than 5 days (2), and
septicemia (1). Note that these statistics apply only to traumatic hemothorax.
