Authors: J. Šiller; K. Havlíček Authors‘ workplace: Katedra klinických oborů, Fakulta zdravotnických studií Univerzity Pardubice ; Chirurgická klinika, Pardubická krajská nemocnice, a. s., přednosta: doc. MUDr. K. Havlíček, CSc. Published in: Rozhl. Chir., 2009, roč. 88, č. 5, s. 277-281. Category: Monothematic special - Original
Background: Haemothorax is frequent consequence of blunt and penetrating thoracic trauma and is usually associated with pneumothorax. The occurence of haemothorax in blunt thoracic trauma patients is estimated between 25–75%. The reason of bleeding is impairment of intercostal arteries or lung parenchyma after trauma of the ribs. Uncontrolled bleeding is the main cause of the death. The article is focused on the treatment of this injury.
Material and methods: There were enrolled 238 patients with thoracic trauma, who were admitted into our department, into the study. The average age of the patients was 42.5 years. The ISS ≥ 16 were in 101 patients. Forty two patients were artefitially ventilated. Conservative treatment prevails, almost in 65%. Special care was indicated in patients with haemothorax (fluidotoraxem).
Results: Clinically and based on other screening methods the presence of the fluid in thoracic cavity was in 131 patients. Surgical treatment (punction, drainage, videothoracoscopy and thoracotomy) was necessary in 47 (35.0%). Thoracotomy for the bleeding was indicated in seven cases (5.3 %).
Conclusion: In diagnostics and in treatment of the bleeding in thoracic trauma patients the most important factor is clinical status of the patient. Indication for thoracotomy must be unambigous. Massive haemotorax leads to restrictive ventilation disorder with decreased preload and can be activator of the haemocolaguation disorders. This fact decreases chance for the survival of the patient.
Key words: blunt thoracic trauma – haemotorax – treatment
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