Lecture Notes: Hemothorax

Introduction

• Speaker: Eddie Watson
• Goal: Simplify complex critical care subjects like hemothorax for ICU confidence
• Resources: Notes available to YouTube and Patreon members, quizzes, and support through merchandise

Understanding Hemothorax

• Definition: Blood collection in the pleural space
  • Disrupts lung function by taking up space and applying pressure
  • Leads to alveolar hypoventilation, V/Q mismatch, and anatomical shunting
  • Large hemothorax can cause tension hemothorax, affecting cardiac function
  • Potential for significant blood loss leading to hemorrhagic shock

Causes and Classification

• Traumatic Hemothorax: Most common
  • Caused by penetrating or blunt trauma (e.g., rib fractures)
  • Risks higher with anticoagulants
• Iatrogenic Hemothorax: Medical procedures (e.g., central line insertion)
• Non-Traumatic or Spontaneous Hemothorax
  • Less common, causes include cancer, vascular disorders, or combined pneumothoracies (pneumohemothorax)

Signs and Symptoms

• Similar to pneumothorax: chest pain, dyspnea, reduced breath sounds
• Specific to hemothorax: tachycardia, dull percussion, chest asymmetry
• Tension hemothorax symptoms: JVD, tracheal deviation, hypoxemia, hypotension

Diagnosis

1. Chest X-Ray
   • PA X-ray shows blunting of the costophrenic angle and opacification
   • Supine X-ray may not show clear collection due to layering
2. CT Scan
   • Detailed view of location, size, and other injuries
   • Used post-stabilization in trauma cases
3. Ultrasound
   • Increasingly preferred for rapid assessment
   • Detects small hemothoracies better than X-ray
   • Used in FAST and E-FAST protocols for trauma

Treatment Options

• Conservative Treatment
  • Minor hemothoracies (<300 mls) monitored and managed with analgesics
• Thoracentesis: Rare, used for some hemothoracies
• Chest Tube
  • Gold standard for drainage and monitoring
  • Inserted lower than for pneumothorax, typically at 5th intercostal space
  • Larger tubes (32-40 French) preferred to prevent clotting
• Blood and Volume Replacement
  • Blood preferred for hypovolemia; fluids initially if needed
• Embolization
  • For arterial bleeds, done via IR
• Surgery
  • Required for significant bleeds or complications (e.g., thoracotomy or VATS)
  • Necessary for clotted hemothoracies

Conclusion

• Importance of recognizing and diagnosing hemothorax
• Understanding symptoms and treatment options essential for ICU care
• Encouragement to subscribe and support the channel for further learning