Massive Hemothorax

Question 1

1) Describe Massive hemothorax. (2)
2) How much blood loss is considered massive?

Answer 1

1) - Blood collecting in the intrapleural space
- Can result from either penetrating/ blunt chest trauma
2) Massive hemothorax: Blood loss >1500 mL within 3 hours or >200 mL/hr for consecutive 2-4 hours

Question 2

Where are the typical sources of bleeding in massive hemothorax? (4)
(thorax=lungs)

Answer 2

Lungs
Major vessels
Intercostal vessels
Heart

Question 3

Physical signs of massive hemothorax. (6)

Answer 3

• Hemorrhagic shock: pallor, hypotension, tachycardia, cool peripheries
• Reduced chest movement
• Present/absent distended neck veins
• Tracheal shift to opposite side
• Dullness on percussion
• Absent/diminished breath sounds

Question 4

Treatment of massive hemothorax. (4)

Answer 4

• Chest tube insertion for drainage of blood
• Rapid blood volume transfusion:
  
  • rapid blood transfusion (may need to activate MTP)
  • 10-20% of cases will require thoracotomy