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Hemothorax, Emergency Medicine

Anthony C. Salazar Reviewed 06/2017
 


Basics

Description

  • Accumulation of blood in the intrapleural space after blunt/penetrating chest trauma or other nontraumatic etiology. Bleeding is usually a result of disruption of the tissues/vessels...

Diagnosis

Signs and Symptoms

  • Small amount of blood in thorax (<400 mL): Little or no change in patient's appearance, vital signs, or physical findings

  • Large amount of blood (>1,000 mL): Restlessne...

Treatment

Pre-Hospital

  • Assess vital signs and pulse oximetry; administer oxygen and obtain IV access.

  • Fluid resuscitation as needed for hypotension

  • Cautions:

    • Difficult to differentiate hemothoraces from p...

Follow-Up

Disposition

Admission Criteria

Patients with hemothoraces requiring tube thoracostomies should be admitted for monitoring and thoracostomy tube management to the trauma, cardiothoracic, or gen...

Pearls and Pitfalls

  • Because the pleural cavity of an average 70 kg man can hold over 4 L of blood, an exsanguinating hemorrhage can occur without any evidence of external blood loss.

  • Auscultation and p...

Additional Reading

  • Ali  HA, Lippmann  M, Mundathaje  U, et al. Spontaneous hemothorax: A comprehensive review. Chest.  2008;124(5):1056–1065.

  • McEwan  K, Thompson  P. Ultrasound to detect haemothor...

Codes

ICD9

  • 511.89 Other specified forms of effusion, except tuberculous

  • 860.2 Traumatic hemothorax without mention of open wound into thorax

  • 860.3 Traumatic hemothorax with open wound into thorax

  • 860.4 Tr...

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