Haemothorax after Blunt Thoracic Trauma
Authors:
J. Šiller; K. Havlíček
Authors‘ workplace:
Katedra klinických oborů, Fakulta zdravotnických studií Univerzity Pardubice
; Chirurgická klinika, Pardubická krajská nemocnice, a. s., přednosta: doc. MUDr. K. Havlíček, CSc.
Published in:
Rozhl. Chir., 2009, roč. 88, č. 5, s. 277-281.
Category:
Monothematic special - Original
Overview
Background:
Haemothorax is frequent consequence of blunt and penetrating thoracic trauma and is usually associated with pneumothorax. The occurence of haemothorax in blunt thoracic trauma patients is estimated between 25–75%. The reason of bleeding is impairment of intercostal arteries or lung parenchyma after trauma of the ribs. Uncontrolled bleeding is the main cause of the death. The article is focused on the treatment of this injury.
Material and methods:
There were enrolled 238 patients with thoracic trauma, who were admitted into our department, into the study. The average age of the patients was 42.5 years. The ISS ≥ 16 were in 101 patients. Forty two patients were artefitially ventilated. Conservative treatment prevails, almost in 65%. Special care was indicated in patients with haemothorax (fluidotoraxem).
Results:
Clinically and based on other screening methods the presence of the fluid in thoracic cavity was in 131 patients. Surgical treatment (punction, drainage, videothoracoscopy and thoracotomy) was necessary in 47 (35.0%). Thoracotomy for the bleeding was indicated in seven cases (5.3 %).
Conclusion:
In diagnostics and in treatment of the bleeding in thoracic trauma patients the most important factor is clinical status of the patient. Indication for thoracotomy must be unambigous. Massive haemotorax leads to restrictive ventilation disorder with decreased preload and can be activator of the haemocolaguation disorders. This fact decreases chance for the survival of the patient.
Key words:
blunt thoracic trauma – haemotorax – treatment
Sources
1. Hájek, M. Traumatologie hrudníku. Praha, Avicenum, 1980.
2. Drábková, J. Polytrauma v intenzivní medicíně. Praha, Grada Publishing, 2002.
3. Šafránek, J., Špidlen, V., Klečka, J., Vodička, J., Šimánek, V. Torakotomie pro hrudní trauma. Úraz. Chir., 2005; 13: 1–4.
4. Meredith, J. W., Hoth, J. J. Thoracic Trauma: When and How to Intervene. Surg. Clin. North Am., 2007; 87: 95–118.
5. Moore, E. E., Feliciano, D. V., Mattox, K. L. Trauma. McGraw-Hill, New York, 2004.
6. Garcia, A. Critical Care Issues in the Early Management of Severe Trauma. Surg. Clin. North. Am., 2007; 87: 1359–1387.
7. Vyhnánek, F. Diagnostické a léčebné postupy u torakoabdominálních poranění – současný stav. Rozhl. Chir., 2007; 86: 397–403.
8. Gracias, V. H., McGonigal, M. D. Monitoring organ function. Crit. Care Tr. Pat., 2000; 80: 911–917.
9. Mirvis, S. E., Shamnuganathan, K. Imaging in trauma and critical care. Second edition, Sauders, 2003: 297–361 (Diagnostic Imaging of Thoracic Trauma).
10. Trupka, A., Waydhas, C., Halfeldt, K. K., et al. Value of Thoracic Computer Tomography in the First Assessment of Severely Patients with Blunt Chest Trauma: Results of a Prospective Study. J. Trauma, 2007; 43: 405–412.
11. Lukáč, L., Pleva L., Prusenovský, P. Nestabilní hrudník a poranění srdce. Úraz. Chir., 2007; 15: 4–7.
12. Trefanec, J. Poranění srdce při tupém traumatu hrudníku. Lék. Listy, 2002; 15: 26–29.
13. Novotný, J., Peregrin, J. H., Pirk, J. Terapie traumatických ruptur hrudní aorty implantací stentgraftu. Úraz. Chir., 2003; 11: 1–6.
14. Tiesenhausen, K., Amman, W., Koch, G., et al. Endovascular stentgraft repair of acute thoracic aortic dissection – early clinical experiences. Torax Cardiovasc. Surg, 2001; 49: 16–20.
15. Potaris, K., Mihos, P., Gakidis, I. Role of video-assisted thoracic surgery in the valuation and management of thoracic injuries. Interact. Cardiovasc. Thorac. Surg., 2005; 4: 292–294.
16. Committee on Trauma, American College of Surgeons: ATLS Instructor Manual. Chicago. Am. Col. Surg., 1993.
17. Kieslichová, E. Masivní krevní ztráta: hemodynamické změny a možnosti jejich ovlivnění. Bull. HPB Chir., 2004; 12: 120–123.
18. Cvachovec, K. Problematika krvácení a kolidní objemové náhrady. In: Křivánkovy dny, Polytrauma, Sborník, 2007: 26–28.
19. Alam, H. B., Rhee, P. New Developments in Fluid Resuscitation. Surg. Clin. North. Am., 2007; 87: 55–72.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2009 Issue 5
Most read in this issue
- Haemothorax after Blunt Thoracic Trauma
- Acute Mediastinitis – Optimum Diagnostic and Therapeutic Measures
- Inflammatory Diseases of the Thorax
- Malignant Mediastinal Teratoma – A Case Review