April 21, 2012

Image of the Day 5: Left Hemothorax








This unfortunate young man was brought to the emergency department after involve in motor vehicle accident (Motorbike vs lorry) where his body smashed against the lorry. He sustains loss of consciousness for about 5 minutes, retrograde amnesia, chest pain and shortness of breath. This is the chest x ray of the patient which shows opacity of the left hemithorax up to the upper zone with obliteration of costophrenic angle. The trachea is shifted to the right. After further evaluation, a diagnosis of Cerebral Concussion with left hemothorax was made and chest tube was inserted.


In this section, i will briefly discussed about hemothorax. Bear in minds that hemothorax can be a life threatening or the lethal one for the patient. Small hemothorax sometimes left undiagnosed and patient was discharged home with sequale of progressive on going bleeding.


As in this case, blunt trauma is one of the causes for hemothorax. Others would be penetrating chest trauma, iatrogenic and spontaneous.


As a general rule, if hemothorax is obscuring the costophrenic sulcus or associated with pneumothorax, therefore it should be drained via chest tube. In case of massive hemothorax; 1) More than 1000 cc blood drained post insertion of chest tube, 2) more than 150-200 ml/hr blood drained for 2-4 hours, 3) Requirement of repeated blood transfusion to maintain hemodynamic stability, surgical intervention would be needed.


Other measure needed in resuscitating this patient includes, 1) evaluation of airway patency, 2) two large bore IV access preferably in the ante cubital fossa, 3) Strict I/O monitoring, 4) Folley’s catheter insertion, 5) GXM of at least 3 pints packed cells, 6) Reserve a GSH as we may need to convert to whole blood and DIVC regimes later depending on patient condition. 7) Monitoring of vital sign, blood parameter, baseline ECG, 8) Insertion of Central venous line if required intensive monitoring, 9) KIV for intubation if patient condition deteriorated, 10) Fluid resuscitation and maintenance. Do not use crystalloid containing dextrose even for maintanance as this patient having cerebral concussion, 11) Evaluation of other systemic injury and finally 12) To treat any associated injury (Due to trauma or any metabolic derangement due to hemothorax)


Sequale of hemothorax including residual clot, infected collections, and trapped lung due to fibrothorax or empyema.


Reference:
1. Hemothorax by Mary C. Mancini
http://emedicine.medscape.com/article/2047916
Accessed on 21 April 2012, 1.30 pm



20 comments:

  1. Hi, probably our entry may be off topic but anyways, I have been surfing around your blog and it looks very professional. It’s obvious you know your topic and you appear fervent about it. I’m developing a fresh blog plus I’m struggling to make it look good, as well as offer the best quality content. I have learned much at your web site and also I anticipate alot more articles and will be coming back soon. Thanks you.



    Medical Writing Service

    ReplyDelete
  2. can i know what is the meaning of costophrenic sulcus?

    and what is the meaning of these abbrevations?
    I/O
    GXM
    GSH
    DIVC

    what does Central venous line monitor ?? BP ?

    ReplyDelete
  3. Ranjini: Thank you

    Jasperseng:

    costophrenic come from the word costo= rib and phrenic = diaphragm... literally means the angle between the diafphram n ribs in the chest x ray..


    the abbreviations are the most commonly used abb. by medical professional in malaysia...


    I/O= input output
    GXM: Group cross match
    GSH: Group, screen and hold
    DIVC: disseminated intravascular coagulopathy


    CVP did not monitor BP my dear.. it use to minitor the pressure inside the central vein, in the IJV just above the right atrium... we need to maintain normal cvp in which it correlates well with fluids inside the vessel...

    ReplyDelete
  4. thank you very much for explaining.
    and the abbreviations i never see them before. i am currently studying in Russia... they dont use abbreviations much.

    i have a lot more to learn from your blog. hope you dont mind answering my list of question haha.

    ReplyDelete
  5. Hi may I ask why is the right lung field so black?

    ReplyDelete
  6. easily wanna remark that you have a very decent web location, I relish the design and style it really stands out. vigrx I believe you have commented some very intriguing minutia, considers for the post..proofreading essay

    ReplyDelete
  7. I adore the dear data you supply in your articles. i am going to marker your diary and have my children ascertain over here generally. we tend to rectangle measure rather affirmative the will learn numerous new stuff here than any person else!

    ReplyDelete
  8. Overpopulation is, certainly, a grave socio-economic problem of India. This difficulty has unfavorably exaggerated the growth of the wealth and the typical of the living of the citizens the trouble is a vital one and needs instantaneous key. http://rushmywriting.com/essay-writers Overpopulation is associated to the size of the people and the populace and the use of the country wealth.

    ReplyDelete
  9. This is my first time i visit here. I found out so many amusing stuff in your blog, particularly its consideration. From the tons of comments on your pieces, I estimate I am not the only one having all the leisure here! hold up the good work. credit card processors

    ReplyDelete
  10. This is the first instant actually have glimpsed you’re joyous and do reminiscent of to notify you – it's actually pleasing to look at and that i am appreciative for your diligence. while if you expected did it all through a very very easy method that will be actually gracious. whereas over all I very not mandatory you and affirmative can comprise for a alallotmentment of mails like this. many express thankfulness most. auto title loans st. louis

    ReplyDelete
  11. I should say that general I am really leveraged with this blog. It is very easy to glimpse that you are fervent about your conceiving. If only I had your creating skill I look ahead to more modifications and will be approaching back.perfect internet casino for all time which perennially surprising

    ReplyDelete
  12. This is the prime bit I actually have glimpsed you’re comfy and do favour to announce you – it's actually fastidious to glimpse and that i soak up your mighty paid work. although if you probably did it in a clear-cut manner that may be very pleasant. although over all I unquestionably proposed you and clear in your brain can gaze forward to additional mails like this. Thanks most. payday loans oceanside

    ReplyDelete
  13. Equivalent Deposit Bonus. This is where the dwelling will agree your deposit. Often this is finished in multiples. For example, a 200% bonus will mean that if you were to deposit $100 then the casino would add $200 in free casino chips to your account. Very nice! particularly helpful for new players starting out. casinoonline-sverige.com

    ReplyDelete
  14. To conceive with the foremost line of my commentary – I do just like to gift a monster due to the periodical esteem. really it's a large work by him and that i discovered out a high-quality facilitate by his/her satisfying info. I directly need to notify, great pleasure comprise it up your paid work. routinely I’ll assemble certain with your posting and change. admiration ahead to your supplemented mails. cash advance oceanside

    ReplyDelete
  15. I just have a look here and appear large to find out this blog. wealthy content conceiving hand and very cooperative location. I crave most of we who are to find these types of things, here we can find everything. I am with the content esteem and do esteem him as a good provider. onlinecasino777 Thanks for your hard work and you too.

    ReplyDelete
  16. The u. s. OF AMERICA payroll check consumer credit could also be quick and easy. Typically, the leading approach unremarkably simply are needing ten (10) circumstances in addition as a lesser variety of. Your personal Improve loan day sum typically could be a fast loan from the bank which will become due by yourself future financial gain, this is often why all people create contact with these people an entire new Improve loan day auto cash title loans corona.

    ReplyDelete
  17. May u explain more about GSH and GXM ?

    ReplyDelete
    Replies
    1. http://www.docstoc.com/docs/42451977/GXM-GSH#

      Delete
  18. The blog article very surprised to me! Your writing is good. In this I learned a lot! Thank you!

    PhD Thesis Writing Services

    ReplyDelete
  19. Welcome to 25 Delhi Escorts. I am offering relaxing escorts service in Delhi for fun.

    ReplyDelete

Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.