traumatic hemothorax
Introduction
Introduction to traumatic hemothorax The blood in the pleural cavity is called the blood chest. The incidence of traumatic hemothorax accounts for 25% to 75% of blunt trauma in the chest and 60% to 80% of penetrating injuries. The treatment of traumatic hemothorax aims to prevent and treat shock, clear pleural hemorrhage early to relieve lung and mediastinal compression and prevent infection. The clinical manifestations of traumatic hemothorax depend on the amount and rate of bleeding and the severity of the associated injury. Acute blood loss can cause a decrease in circulating blood volume and a decrease in cardiac output. A large amount of blood can compress the lungs and mediastinum, causing respiratory and circulatory dysfunction. A small amount of hemothorax refers to the amount of pleural hemorrhage below 500 ml, and the patient has no obvious symptoms and signs. basic knowledge The proportion of the disease: 0.01% - 0.02% (this disease is mainly caused by trauma, the incidence of common young people is generally 0.01% - 0.02%.) Susceptible people: no specific people Mode of infection: non-infectious Complications: shock empyema
Cause
Traumatic hemothorax
Cause:
1 Lung tissue laceration hemorrhage, due to lower pulmonary circulation pressure, high blood coagulation content in the lung tissue and collapse of the surrounding lung tissue, generally can stop by itself;
2 chest wall vascular hemorrhage, seen in the intercostal movement, vein and thoracic internal motion, venous injury bleeding, if involving higher pressure arteries, the amount of bleeding is more difficult to stop naturally;
3 hilar, mediastinal blood vessel damage and heart rupture, the amount of bleeding is large and rapid, quickly enter the state of shock, patients often do not receive rescue and die;
4 diaphragmatic penetrating injury, can be combined with abdominal organ injury, blood chest is contaminated by bile or gastrointestinal contents, due to defibrination caused by heart, lung, and sputum movement, blood in the pleural cavity for a long time The inside can remain in a non-coagulated state, such as a large amount of bleeding in a short period of time, defibrination is incomplete, and coagulation can occur to become a coagulative hemothorax.
Prevention
Traumatic hemothorax prevention
1, the diet should pay attention to light, mostly with food porridge, noodle soup and other foods that are easy to digest and absorb.
2, can eat more fresh fruits and vegetables to ensure the intake of vitamins.
3, give liquid or semi-liquid food, such as a variety of porridge, rice soup and so on.
4. Pay attention to safety in daily life and avoid mechanical damage.
Complication
Traumatic hemothorax complications Complications
Complications of traumatic hemothorax: high fever, chills, difficulty breathing, empyema, chest pain, shock, blood chest.
Symptom
Traumatic hemothorax symptoms common symptoms dyspnea high fever chest pain empyema shock chill
The clinical manifestation depends on the severity of chest injury, blood volume and speed, and patients with chest penetrating injuries. It can be seen that blood flows from the wound with the breathing movement, and a small amount of hemothorax, the patient can have no obvious symptoms and signs, moderate to large amount. In the blood chest, in addition to the hemorrhagic shock, the patient's intrathoracic pressure increases, the pressure in the chest increases, the mediastinum shifts, the breathing is difficult, and the respiratory movement is significantly weakened. The intercostal space is full, the chest percussion is dull, the trachea, the mediastinum shifts to the healthy side, the breath sounds are obviously weakened or disappeared, and a large amount of blood will quickly enter the shock state, and the patient often cannot be rescued and died.
Chest penetrating injury, anaerobic bacteria or spore-like infections due to foreign body retention or sharpness in the chest, high fever, chills, chest pain and other symptoms of poisoning, such as inflammation limitations, localized empyema may occur.
Examine
Traumatic hemothorax examination
1. X-ray examination: X-ray chest radiography is very important. Patients with 1000ml hemothorax may have a slight diffuse density increase shadow on the chest X-ray. It may be mistaken for pleural reaction. In some cases, , less than 300ml of blood chest, even in the upright position X-ray chest film is difficult to judge, more than a moderate amount of bleeding, X-ray chest radiograph can be seen in the pleural cavity of the injured side of the effusion shadow, the mediastinum shift to the opposite side, such as merger The pneumothorax shows the gas-liquid plane.
2. B-mode ultrasonography of the chest: the liquid dark area formed by the effusion in the pleural cavity of the injured side. When the amount of bleeding is large, there is a liquid dark area where hemorrhagic heterogeneous density may occur due to non-coagulation.
3. Chest CT examination: visible pleural hemorrhage in the injured side, can also help to determine the degree of lung injury and chest damage.
Diagnosis
Diagnosis of traumatic hemothorax
1. Traumatic hemothorax has a history of chest trauma (including iatrogenic). Non-traumatic hemothorax has a history of primary disease (malignant tumor or systemic coagulopathy). Spontaneous hemothorax generally has cough, exercise or negative pressure to increase the position and other incentives.
2. Chest pain, chest tightness, suffocation, pulse gradually increase, blood pressure gradually declines.
3. Laboratory examination: repeated examinations such as hemoglobin, red blood cell count, and hematocrit continue to decline.
4. X-ray performance: a small amount of hemothorax accumulated in the rib sinus, chest X-ray examination may not be easily found, or see the rib angle disappeared. If the amount of blood chest is greater, the density of the injured chest will increase. It is clearly displayed on the lateral chest radiograph. A large number of blood chests show large patches of effusion shadows and signs of mediastinal shift. Chest CT is characterized by pleural effusions of varying capacities. If the blood pneumothorax is at the same time, the liquid level is visible, which is manifested as a sign of liquid and gas chest.
5. Diagnosis can be confirmed by pleural puncture and blood or chest drainage with blood outflow.
6. Patients with hemothorax can be pricked and blood drawn, and the pleural effusion can be increased.
7. Increased shock symptoms or X-ray examination of pleural effusion increased; pleural drainage after more than 200ml per hour and continued for more than 2 hours, suggestive of progressive bleeding, need to be treated in time.
