Hemothorax - how frequent?

[DwayneEMTP]

Herbie and Beiber back, finally, on the same day in the same thread?

I smell something fishy here....

Welcome back guys..you've been missed!

Dwayne

[PCP]

Welcome to the City!

No need for a thrashing.

Hemothorax is the accumulation of blood in the pleural space due to internal hemorrhage which is associated with rib fractures as well as laceration of the intercostal arteries, pulmonary arteries, great vessels, or the internal mammary arteries.

A Pericardial Tamponade is when there is excess fluid that accumulates inside the pericardium. When this happens the excess fluid causes an increase in intrapericardial pressure that impairs diastolic filling and decreases the amount of blood the ventricles can expel with each contraction.

If anybody can explain it better please do so.

Brian

[JasonEMT]

Welcome to the City!

No need for a thrashing.

Hemothorax is the accumulation of blood in the pleural space due to internal hemorrhage which is associated with rib fractures as well as laceration of the intercostal arteries, pulmonary arteries, great vessels, or the internal mammary arteries.

A Pericardial Tamponade is when there is excess fluid that accumulates inside the pericardium. When this happens the excess fluid causes an increase in intrapericardial pressure that impairs diastolic filling and decreases the amount of blood the ventricles can expel with each contraction.

If anybody can explain it better please do so.

Brian

Very clear. Thanks for the info, and the welcome.

[Richard B the EMT]

Luck of the draw. Never had either, over 38 years.

I did, however, see anoter crew bring in a stabbing victim, knife still in the chest, quivering with each heartbeat. Patient was a gangbanger, made it clear to the LEOs he'd handle the situation on his getting out of the ER. Was also filmed by one of the EMS "Ride-Along" shows, who were inside the ER with yet a third crew on another assignment. This was at Lincoln Hospital, Bronx NY, in the late 1980s or early 1990s.

Forgive my manners: WELCOME!

[Hutsy]

Last week I learned that our patient did survive. It made me feel good.

[Tactical Spork]

Hello all,

I have a question for the group somewhat related to the topic at hand. My question is related to chest tubes and hemothorax management. I am looking for people's views on clamping the chest tube if it is putting out a lot of blood (say >1500mL post placement, or >200mL/hr to use classic textbook numbers). For discussion sake a thoracotomy is not an option as the patient is being transported to a trauma facility (via ground or air depending on your background).

Looking forward to the feedback/discussion.

TS

Edited October 28, 2011 by Tactical Spork

[DFIB]

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.

I have video of a beating knife in the heart. It was kind of cool to watch the heart rate in the knife handle.

Only in my video the knife is stuck in a hog.

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

Around here most suicides are hangings.

I have seen one pneumothorax but no tamponades or hemothorax.

You might want to Google Beck's Triad.

Edited October 28, 2011 by DFIB

[usalsfyre]

Hello all,

I have a question for the group somewhat related to the topic at hand. My question is related to chest tubes and hemothorax management. I am looking for people's views on clamping the chest tube if it is putting out a lot of blood (say >1500mL post placement, or >200mL/hr to use classic textbook numbers). For discussion sake a thoracotomy is not an option as the patient is being transported to a trauma facility (via ground or air depending on your background).

Looking forward to the feedback/discussion.

TS

Unless you've got blood or an autotransfuser you must clamp the tube. Even with blood or an auto transfuser I'm probably going to clamp a chest tube at way less than a liter and a half. Otherwise it's easy to end up with the patients entire blood volume in the chest drain.

[systemet]

Just wanted to add:

* U/S is the best way to dx tamponade, Beck's triad is pretty insensitive, even in the hands of physicians.

* Most of us probably aren't that fantastic at deciding whether heart sounds are muffled.

[DFIB]

Ultrasound stethoscopes, Are they already on the market? I know they were developing them.