Hemotorax

Hemotorax

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Hemotoraxul (or hemotorace) is a condition resulting in the accumulation of blood in the pleural cavity. The cause is usually traumatic, the shot wound or chest injury, with rupture of the serous membrane covering the lungs. This gap allows opening the pleural space, and equalize the pressure between the lungs. Massive blood loss may be the people with this condition, each side of the chest being able to sustain 40% of a person's blood. Even minor damage can lead to chest wall hemotorax.
Left untreated, hemotoraxul can progress to the point where the blood accumulation begins to put pressure on the mediastinum and trachea, effectively limiting the amount that one can include the ventricles. The condition can cause tracheal deviation toward the unaffected.
A hemotorace is controlled by removing the source of bleeding and by draining the blood already in the chest cavity. Blood in the cavity can be removed by inserting a drainage procedure called toracostomie. Lung will expand and the bleeding will stop after the blood tube is inserted. Blood can thicken and the chest is activated by the pleural surface. As the blood becomes viscous can coagulate in the pleural space, leading to occlusion by clots hemotorax detained or drainage tube.
In some cases the chest can become infected blood-empyema. Trying to minimize blood clotting is essential for hemotorax treated with tube drainage. Thrombolytic agents are used to break up clots in tubes or when the clot becomes organized into the pleural space. In some cases surgery is necessary sngerarea and continue to stop the bleeding source.
Pathogenesis and causes Hemotoracele refers to a collection of blood in the pleural cavity. Although some doctors believe that a hematocrit below 50% is enough to define comparable hemotoracele pleurisy, most do not agree with this differentiation. Hemotoracelui most frequent etiology is shot wound or penetrating trauma, but can result in a number of cases and nontraumatic or spontaneous.
Bleeding into the pleural cavity can occur in any tissue of the chest injury. Physiological response to the development of hemodynamic and respiratory hemotoracelui occurs. The degree of hemodynamic response is determined by quantity and speed of blood loss. Normal respiratory movements can be blocked by the effect of replacement space. In cases of trauma, ventilation and oxygenation abnormalities may result, especially if associated with chest wall lesions. In some cases of nontraumatic origin, especially those associated with pneumothorax and a small amount of blood, respiratory symptoms may predominate.
Physiological systemic-hemodynamic response: Hemodynamic changes vary depending on the amount of blood loss and its speed. Blood loss of up to 750 ml in a 70 kg person does not cause significant hemodynamic changes. 750-1000 ml of blood loss from the same person will result in symptoms of shock: tachycardia, tachypnea and decreased heart rate. Signs of shock with poor perfusion loss affects over 30% of assets. Because the pleural cavity may comprise more than four liters of blood, bleeding can occur without obvious by exsanguinizare external blood loss.
Systemic-respiratory physiological response: Blood pleural cavity which occupies the place that would fill the lungs with normal respiratory air trip intro. A collection big enough lead to accusations of dyspnea and tachypnea. The volume of blood needed to produce these symptoms varies depending on a number of factors: organ damage, severe injuries, cardiac and pulmonary reserve. Dyspnea is a common symptom in cases where hemotoracele intro develops insidious manner, and in secondary metastatic disease. Loss of blood in such cases there is acute hemodynamic response to produce visible and dyspnea is often the main accused.
Hemotoracelui physiological Resolution: Blood entering the pleural cavity is exposed to movements in the diaphragm, lungs and other intrathoracic structures. This process determines defibrinarea blood clotting and incomplete. In a few hours after the termination of existing clot lysis begins singerarii by enzymes effusions.
Physiological sequelae of late hemotoracelui unresolved: Two horses are associated with pathological stages of hemotoracelui late. These include empyema and fibrotoracele. Bacterial contamination resulting empyema hemotoracelui remember. If not detected or adequately treated it can lead to bacteremia and septic shock. Fibrotoraxul arise when storage occurs in fibrin glue hemotorace organized and parietal and visceral pleural surfaces. Lung is fixed in position by adhesive processes and can not expand fully. Atelectaziile portions persistent pulmonary sequelae and lung function is reduced in this process. Hemotoracelui causes are: -Gunshot trauma, penetrating trauma -Primary or metastatic neoplasia Complications including blood-clotting dyscrasia Heart-lung embolism -Those application in combination with spontaneous pneumothorax pleural -Bullous emphysema, necrotizing infections -Tuberculosis, pulmonary arteriovenous fistulas Hereditary bleeding-teleangiectaziile -Thoracic aneurysm aortic aneurysm mammary artery Intralobar or extralobar-seizure -Pancreatic pseudocyst, splenic artery aneurysm, hemoperitoneul -Catamenial.