Hemothorax - how frequent?

[Hutsy]

Heya, first post since my introduction. I'm not a particulary active poster as you can see...

But here we go.

Some time back I had a patient who rammed a knife into his chest cavity, lucky he missed his lungs as we saw no bubbles, but we later learned he managed to rupture a coronary artery (massive decrease in bloodpressure). He won the prize of a hemothorax + coronary thrombosis, woop. This particular scenario is quite rare where I live (1-5 times a year), but out of curiosity I was wondering how often you see/hear this happening in your area? People getting stabbed is one thing but this was him doing all the work with suicidal intent.

On the other hand we have loads of OD's on opioids...

Thanks for reading.

[BushyFromOz]

Bit confused bloke, are you asking how frequently penetratin trauma causes haemothorax, or anecdotally, how many stabbings we do as providers where we work?

Also the coronary artery rupture/thrombosis bit is uber confusing.

by the way, welcome to the city

Edited July 8, 2011 by BushyFromOz

[Happiness]

Iv seen it twice in my career, 6 self induced stabs to the abdominal and about 5 years later one to the chest just narrowing missing anything important, and the kicker it was the same person......

Edited July 8, 2011 by Happiness

[Hutsy]

Bit confused bloke, are you asking how frequently penetratin trauma causes haemothorax, or anecdotally, how many stabbings we do as providers where we work?

Also the coronary artery rupture/thrombosis bit is uber confusing.

by the way, welcome to the city

I am asking how many suicidal stabbings like these you get where you work, yep.

Sorry for the confusion. The membrane which surrounds the heart was ruptured which resulted in blood seeping in...

Also thanks for the welcome.

[HERBIE1]

I am asking how many suicidal stabbings like these you get where you work, yep.

Sorry for the confusion. The membrane which surrounds the heart was ruptured which resulted in blood seeping in...

Also thanks for the welcome.

Welcome to the city!

So you are talking about a self inflicted cardiac tamponade? Yeah, pretty rare. I worked in a very busy Level One Trauma center for 10 years and only saw a few. I do recall one good one- not self inflicted, but a knife sticking out of a guy's chest, buried in his heart, pulsing with each heartbeat. He survived.

Prehospitally- maybe 2-3 that I know of in 30 years.

[Bieber]

Can't say I've ever seen a hemo- or pneumothorax yet! I eagerly await the opportunity to decompress a pneumo, though. Come to think of it, I haven't ever run any stabbings either; though I recently had a knife wound to the back (slashing injury), but it didn't go much deeper than the dermis.

[Hutsy]

Thanks for your replies. Sounds like I was quite "lucky" to witness this so early in my career! I don't know whether the patient lived or not, though he was (barely) alive by the time we rolled him into the ER; Last BP measurement was at 50/30something. He was pale and a bit cyanotic. Best part is he was still awake.

[Hutsy]

Noticed I wrote thrombosis instead of tamponade. When I was discussing the case with one of my peers I got laughed at because I didn't realize I said trombone instead of thrombo- er, tamponade.

[firemedic37]

I have seen two Hemothoraxs in my career of five years, they were both in the hospital setting and one was a car vs. pedestrian and the other was a gunshot. Neither lived, both had their chest opened in the ED.

Pneumothoraxs on the other hand are much more common at least for me, I had one while I was doing ride time and the lead paramedic refused to decompress it since he has never done or seen one in his 25 years of being a paramedic, but don't worry the flight crew didn't do it either. They let the ED doc put a chest tube in. I have had three in the field all successfully decompressed before getting to the hospital, two developed (or at least discovered) en route and the other was found on initial assessment.

[JasonEMT]

Welcome to the city!

So you are talking about a self inflicted cardiac tamponade?

Forgive my ignorance as I just completed my EMT class last week but I have a question. Is a hemothorax and a cardiac tamponade the same? I thought a hemothorax was when fluid invaded the plural space and caused pressure that kept the lung(s) from being able to inflate, and a tamponade was a build up of fluid in the pericardium? Keep in mind I'm a newbie, so don't thrash me too hard...