Haemothorax

Haemothorax

1. Haemothorax Submitted by – Nisha Gautam Submitted to – Dr. Jamal Moiz Submission date -05- 01-2021

2. Definition :- presence of significant amount of blood in the pleural space . Causes Trauma: Penetrating Medical- Pulmonary embolism - Non penetrating - Ruptured aorticaneurism - Iatragenic

3. Clinical presentation :- Chest pain Dyspnea Fever Tachycardia Reduced breath sounds on the affected side Pallor Cold sweats

4. source of blood - Chest wall - Lung - Mediastinum - Diaphragm Blood entering the pleural space coagulate rapidly and defibrinated due to physiologic movement of heart & lung.

5. Traumatic hemothorax High incidence in blunt chest trauma Hemothorax most common with displaced rib # Concomitant occurrence of hemothorax & pneumothorax is common whether the trauma is blunt or penetrating. Diagnosis : CXR , CT scan Treatment : Immediate ICT insertion VATS

6. VATS ( video–assisted thoracoscopic surgery ) Indications: no precise criteria available but - If Bleeding >200 ml/ hr & no signs of slowing bleeding (bleeding is not from misplaced central line should be ensured) - Exsanguinating hemorrhage through the chest tube VATS is very effective in – - Hemodynamically stable patient with persistent bleeding. - Controlling bleeding from intercostal vessels with lung lacerations

7. Complications of Haemothorax Clot Retention(3%) Pleural infection (3 to 4 %) Pleural effusion (13-34%) Fibrothorax(<1%)

8. Iatrag enic Hemothorax Causes- Central venous catheterization Thoracocentesis Pleural biopsy Rare cause percutaneous lung aspiration or biopsy trans bronchial biopsy In ICU- common following invasive procedure in patient with CRF Treatment - ICT

9. Non traumatic haemothorax Cause: Malignant pleural disease (most common) Sarcoma angiosarcoma Bleeding disorder- hemophilia , thrombocytopenia - Complication of spontaneous pneumothorax rupture coarctation of aorta, Diagnosis: Pleural fluid RBC > 50% of blood. Treatment - ICT - thoracotomy / VATS- [If bleeding >100ml/ hr ] - Angiographic embolization [if bleeding from intercostal artery

10. Diagnosis procedures :- Chest x-ray Ultrasound CT scan MRI scan

11. Haemothorax complication anticoagulant therapy :- Occurs mainly in treatment of pulmonary embolism Drugs responsible heparin warfarin enoxaparin Hemothorax is apperent 4-7 days of initiation of treatment mainly Treatment - Discontinuation of anticoagulant - Immediate ICT

12. Physiotherapy treatment :- The patient clinical picture should lead the physiotherepist in deciding what treatment is suitable. If the patient has a chest tube and intercostel drain in ,the treatment might be different from when the patient had surgery . Help to improve ventilation , oxygenation and to re-inflate atelectatic lung areas. This could be done through Deep breathing exercise technique. Assisting with mobalisation or strengthening exercises to improve patient’s exercise tolerance and mobility. Help to maintain airway clearance. This could be done by assisted coughing techniques to help clear any secretions.