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HEMOTHORAX

The document discusses hemothorax, which is the presence of blood in the pleural space of the chest. It defines hemothorax, describes the causes such as trauma or medical conditions, clinical presentation, types including traumatic, non-traumatic, and iatrogenic hemothorax. It also discusses diagnosis, complications, management including tube thoracostomy, thoracoscopy, thoracotomy, and VATS. Therapy considerations for hemothorax complications from anticoagulation are also outlined.

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47 Rushi Shinde
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124 views

HEMOTHORAX

The document discusses hemothorax, which is the presence of blood in the pleural space of the chest. It defines hemothorax, describes the causes such as trauma or medical conditions, clinical presentation, types including traumatic, non-traumatic, and iatrogenic hemothorax. It also discusses diagnosis, complications, management including tube thoracostomy, thoracoscopy, thoracotomy, and VATS. Therapy considerations for hemothorax complications from anticoagulation are also outlined.

Uploaded by

47 Rushi Shinde
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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HEMOTHORAX

NAME: RUSHIKESH SANTOSH SHINDE


COLLEGE: SMBT AYURVED COLLEGE AND HOSPITAL, DHAMANGAON.
HEMOTHORAX
 Definition
 Hemothorax -: Presence of Significant Amount of Blood in Pleural
Space .
 Causes
 Trauma:
1 Penetrating
2 Non Penetrating
3 Iatrogenic
4 Medical; Pulmonary Embolism, Ruptured Aortic Aneurysm
C LI N I CAL PR E S E N TAT I O N

 Chest Pain
 Dyspnoea
 Fever
 Tachycardia
 Pallor
 Cold Sweat
 Reduced Breathe Sounds at Affected Site
BLOOD SOURCE

 Chest Wall
 Mediastinum
 Diaphragm
 Lungs

 Blood Entering into Pleural Space Coagulate rapidly and


Defibrillated Due to physiologic movement of Heart and
Lungs.
TYPES

1. TRAUMATIC HEMOTHORAX
 High Incidence in Blunt Chest Trauma.
 It’s Most Common with Displaced Ribs.
 Concomitant Occurance of HEMOTHORAX is Common
whether the Trauma is Blunt or Penetrating.
TYPES

2. NON-TRAUMATIC HEMOTHORAX
 CAUSES
 Pleural Malignancy (Sarcoma, Angiosarcoma)
 Bleeding Disorders (Hemophilia, Thrombocytopenia)
 Complication of Spontaneous Pneumothorax
 Ruptured Coarctation of Aorta.
TYPES

3 .IATROGENIC HEMOTHORAX
 Central Venous Catheterization
 Thoracocentesis
 Pleural Biopsy
 Rare Causes
 Percutaneous Pleural Aspiration or Biopsy
 Trans Bronchial Biopsy
 In ICU; Common Following Invasive Procedure In patient with CRF.
DIAGNOSIS

 Chest X-Ray
 USG
 CT Scan
 MRI Scan
C O M PLI CAT I O N S

 Clot Retention (3 %)
 Pleural Infection (3-4 %)
 Pleural Effusion (13-14 %)
 Fibrothorax (>1 %)
MANAGEMENT

 Tube Thoracostomy drainage is Primary mode of Treatment for


Hemothorax. In adult Patients, large bore chest Tubes, Usually 36-
42 F, should be used to achieve adequate drainage in Adults.
 Most Patients with Hemothorax should be treated with Tube
Thoracostomy should be treated with Tube Thoracostomy which
allows continuous quantification of Bleeding.
 If the Bleeding emanates from Laceration of Pleura apposition. Of
two Pleural Surfaces is Likely to Stop Bleeding.
THORACOSTOMY

 A flexible plastic Tube that inserted through side of Chest


into Pleural Space. It’s used to remove Fluid or Air or Pus
from Intrathoracic Space.
T H O RAC O S C O PY

 Medical Procedure involving internal inspection of


Pleural Cavity with Pleurodesis, can appose pleura or
stick pleurae together eliminating Pleural Space and
preventing Fluid Accumulation.
THORACOTOMY

 AnIncision into Pleural Space of Chest Procedure of


Choice for Surgical Exploration of Chest
 When Massive Hemothorax or Persistent Bleeding is
present at time of Surgical Exploration, the Source of
Bleeding is Controlled and Hemothorax is Evacuated.
V A T S : Video Assisted Thracoscopic
Surgery
 INDICATION:
 If Bleeding is More than 200ml/Hr and no Signs of Slower
Bleeding
(Bleeding is not from Misplaced Central Line should be
Ensured)
 Exsanguinating Haemorrhage through Chest Tube.
 VATS is Effective in:
 Hemodynamically stable patient with persistent Bleeding
 Controlled bleeding from Intercostal Vessels with Lung
Lacerations.
H E M O T H O R A X:
BLUNT TRAUMA ALGORITHM

M I N I M A L ( LESS THAN 500 ML)


 NO PROGRESSION (Repeat Film, Clearing, No
Treatment)
 Increasing Hemothorax
 Bleeding Stops
 Clearing and No Further Treatment
 ContinuesBleeding Exceeding 1000 ml requires
Thoracotomy.
M O D E R A T E (400-800 ML)
 Bleeding Stops
 Clearing and No further Treatment
 PersistentHemothorax requires Thoracotomy continues
Bleeding require Thoracotomy
MAJ O R (MORE THAN 1000ML)
 Pacified Hemothorax (Over 1000ml Intermediate Loss)
 Unstable Patient not responding to Volume
 If loss Continues
 >100 ml/Hr after 6-8 Hrs (Thoracostomy)
 >200 ml/Hr after 2-4 Hrs (Thoracotomy)
T H E RAPY

 HEMOTHORAX COMPLICATION ANTICOAGULANT


THERAPY
 Occurs mainly in treatment of EMBOLISM
 Drugs Responsible:
 Heparin

 Warfarin

 Enoxeparine
PHYS I O T H E RAPY

 The Patient clinical Picture should lead the physiotherapist in


Deciding when treatment is Suitable.
 If Patient has chest Tube and Intercostal drain in treatment might be
different from when patient had Surgery.
 Helps to improve ventillation, oxygenation and to reinstate
atelectasis lung areas. This could be done through deep Breathing
exercise Technique.
 Assisting with Mobalisation or strengthening exercises to Improve
patients exercise tolerance and Mobility.
“
T H A N K Y O U !!!

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