0071643192.pdf

DIAGNOSIS/TREATMENT

■ Diagnosis is clinical.

■ Immediate placement of a 14-g angiocatheter into the second intercostal

space at the midclavicular line should yield a rush of air and decompres-

sion of the pneumothorax.

■ All patients require subsequent chest tube placement.

Hemothorax

MECHANISMS

■ Results from traumatic injury to the chest with bleeding from lung

parenchyma, intercostal arteries, internal mammary artery, and less com-

monly, hilar and great vessels

■ An associated pneumothorax is present in 25% of cases.

SYMPTOMS/EXAM

■ Diminished or absent breath sounds

■ Dullness to percussion (pneumothorax will have resonant percussion)

■ Hypotension

DIAGNOSIS

■ Upright CXR will reveal blunting of the costophrenic angle when >250 mL

blood present.

■ Supine films typically just show haziness even with >1000 mL of blood

present.

■ White-out of one hemithorax implies a massive hemothorax, usually asso-

ciated with mediastinal shift away from the hemothorax.

TRAUMA

FIGURE 3.10. Tension pneumothorax.

(Reproduced, with permission, from Stone CK, Humphries, RL. Current Emergency Diagnosis

and Treatment, 5th ed. New York: McGraw-Hill, 2004:455.)

Serious/symptomatic

pneumothorax:

■ Tension pneumothorax

■ Pneumothorax > 40% of a

hemithorax (2.5 cm from

chest wall in adults)

■ Concurrent with

hemorrhagic shock or

preexisting cardiopulmonary

disease

Lung opacification after

trauma:

■ Massive hemothorax

■ Diaphragmatic rupture

with herniation

■ Lung collapse