HEMOTHORAX

 Hemothorax-is a medical condition where blood pools in between the wall of the chest and the lung. This area is
called the pleural space.
 The most common cause of a hemothorax is chest injury or trauma. It is a form of internal bleeding that can take
place after an accident.
 Other causes include tuberculosis, improper blood clotting, a lung infection, a tear in a blood vessel, or a
complication due to heart surgery. Rib injuries can puncture the lung or chest cavity, causing bleeding.

Pathophysiology:
 In healthy individuals, a small quantity of fluid is present in the pleural cavity that surrounds the lungs. This helps
lubricate and reduce surface tension.
 When a person breathes in, the lungs enlarge, and the fluid fills the entire cavity. In patients affected with
Hemothorax, the lung may collapse due to pressure exerted by the fluid. The pressure exerted by the fluid may also
suppress the cardiac function.
 Chest injuries can result from blunt or penetrating trauma. The most important chest injuries include the following:
 Aortic disruption  Hemothorax
 Blunt cardiac injury  Pneumothorax (traumatic, open, and tension
 Cardiac tamponade pneumothorax)
 Flail chest  Pulmonary contusion

ANATOMY & PHYSIOLOGY

 The lungs take up most of the space inside the chest. The lungs are surrounded by the chest wall. The chest wall is
made up of the ribs and the muscles between the ribs. The lungs are separated by the mediastinum, which contains
the heart and other organs. Below the lungs is the diaphragm, a thin muscle that separates the chest cavity from the
abdomen.
 Each lung is divided into lobes (sections):
 The left lung has 2 lobes. The heart sits in a groove (cardiac notch) in the lower lobe.
 The right lung has 3 lobes and is slightly larger than the left lung.
 The windpipe (trachea) is the tube-shaped airway in the neck and chest. It divides into 2 tubes or branches
called the main bronchi. One bronchus goes to each lung. The area where each bronchus enters the lung is
called the hilum.
 The pleura is a thin membrane that covers the lungs and lines the chest wall. It protects and cushions the lungs and
produces a fluid that acts like a lubricant, so the lungs can move smoothly in the chest cavity. The pleura is made up
of 2 layers:
 inner (visceral) pleura – the layer next to the lung
 outer (parietal) pleura – the layer that lines the chest wall
 The area between the 2 layers is called the pleural space.

WHAT DOES THE LUNGS DO?

 The main functions of the lungs are to transfer oxygen from the air to the blood and to release carbon dioxide from
the blood to the air.
 Air enters the mouth or nose and travels through the windpipe, bronchi and bronchioles to the alveoli. The
exchange of oxygen and carbon dioxide takes place in the alveoli:
 The alveoli absorb oxygen from the air and pass it into the blood, which circulates the oxygen around the body.
 Carbon dioxide, which is a waste product of the body’s cells, passes from the blood into the alveoli and is breathed
out.
 The lungs also play a role in the body’s defences against harmful substances in the air, such as smoke, pollution,
bacteria or viruses. These substances can pass through the nose and become trapped in the lungs. The lungs
produce a thick, slippery fluid (mucus), which can trap and partly destroy these substances from the air. The cilia
move rapidly to push the mucus up through the bronchi, where it is removed by coughing or swallowing.
Risk factors: Clinical Manifestations:
 Chest trauma - Cyanosis
 Blunt or penetrating trauma to chest or lung on - Decreased or absence of breath sound
affected side - Dull resonance on percussion
 Pleural cancer - Unequal Chest Rise
 Blood clotting problems - Tachycardia
 Heart or chest surgery - Hypotension
 Use of a venous catheter - Pale, Cool Clammy Skin
 Death of lung tissue - Dyspnea
 Narrowing pulse pressure

Diagnostic Test:
- Thoracic CT
- Chest X-ray
- Arterial Blood Gas
- Thoracentesis

TREATMENT:
- Relieving symptoms
- Removing the fluid, air, or blood from the pleural space (if a large amount is present)
- Acetaminophen or anti-inflammatory medicines (such as ibuprofen) to control pain.
- Codeine-based cough syrups to control coughing.
- Lying on your painful side. This might make you more comfortable.
- Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, you may develop pneumonia.
- Getting plenty of rest.

Nursing Intervention:
• Promote/maintain lung re-expansion for adequate oxygenation/ventilation.
• Minimize/prevent complications.
• Reduce discomfort/pain.
• Provide information about disease process, treatment regimen, and prognosis.