What is progressive hemothorax ? Conception! Urgent!

Progressive hemothorax refers to blood pressure that does not rise or rises rapidly after blood transfusion and rehydration.

Progressiveness refers to:

Hemothorax refers to: the accumulation of blood in the pleural cavity is called hemothorax, and the hemothorax caused by penetrating injuries such as chest sharps, gunshot wounds or compression, rib fractures and other blunt chest injuries is called traumatic hemothorax. Hemothorax (primary) spontaneous hemothorax secondary to thoracic or systemic disease or iatrogenic coagulation disorder or unknown cause, also known as non-traumatic hemothorax.

Among them, spontaneous hemothorax without an unknown cause of the primary disease is called persistent hemothorax. Hemothorax often occurs at the same time as pneumothorax, called hemopneumothorax. Hemothorax is common in patients with thoracic trauma.

Bleeding can come from intercostal vessels, intrathoracic vessels, pulmonary lacerations, or trauma to the heart and intrathoracic large vessels. The number of hemothorax depends on the size of the vascular rupture, the level of blood pressure and the duration of bleeding, and most pulmonary bleeding is caused by rib fracture broken ends puncturing the pleura and lungs. Due to the small size of the ruptured blood vessel and the low blood pressure in the pulmonary circulation, the bleeding site can often be closed by a blood clot and stop on its own, and the amount of bleeding is usually not much.

If the intercostal artery or the internal thoracic artery is ruptured, the bleeding is not easy to stop spontaneously due to the high blood pressure in the systemic artery, and the bleeding is heavy. Large blood vessels in the heart or chest, such as the aorta and its branches, superior and inferior vena cava and pulmonary arteriovenous rupture are ruptured, the bleeding is profuse, the injury is severe, and the patient often dies of shock due to massive blood loss in a short period of time.

Traumatic, progressive hemothorax refers to blood pressure that does not rise or rises rapidly after blood transfusion and rehydration.

Hemothorax is detected in early thoracic injury, and further determination is needed to determine whether bleeding has stopped or is ongoing.

The following signs suggest progressive bleeding:

1.The pulse gradually increases and blood pressure continues to drop.

2.Blood pressure does not recover or rises rapidly after blood transfusion and rehydration.

3.Repeated measurements such as hemoglobin, red blood cell count, and hematocrit continue to decrease.

4.Pleural puncture does not draw blood due to blood clotting, but serial chest x-rays show that the pleural opacity continues to increase.

5.Symptoms of dyspnea gradually worsen.

6.After closed chest drainage, the amount of blood drained is more than 200ml per hour for more than 3 hours.

Answer]: Common clinical manifestations of progressive hemothorax: Pulse rate gradually increases, blood pressure continues to drop.

After blood transfusion and rehydration, blood pressure does not rise, or it rises temporarily and decreases quickly. Progressive decrease in red blood cell count, hemoglobin, hematocrit. Although there were no abnormal findings in the pleural vertical pure dermal puncture, the residual of the chest x-ray showed that the pleural cavity was becoming more and more opaque.

Closed drainage of the pleural cavity with a blood volume of more than 200 ml h for 3 hours.

Answer]: B test point] Diagnosis of hemothorax.

Analysis] Thoracic drainage of more than 200ml per hour for 3 consecutive hours is a sign of progressive hemothorax, and item B is only 100ml per hour, so it is not a diagnosis of progressive hemothorax, and hemothorax does not coagulate because of the fibrous defibrin effect played by the movement of the lungs, pericardium and diaphragm. If a large amount of blood accumulates rapidly, and the fibrin is exceeded, the intrapleural hemocoagulation is formed, resulting in a coagulant hemothorax, as is the case in item d.

Answer]: B chest drainage for 3 consecutive hours more than 200ml per hour is a sign of progressive hemothorax, B only 100ml per hour, because the posture is not the basis for the diagnosis of progressive hemothorax, and the blood history chest drain blood does not coagulate because of the defibrinization effect played by the movement of the lungs, pericardium and diaphragm. If a large amount of blood accumulates rapidly, the defibrinization effect is exceeded, and the intrapleural blood clots, forming a coagulative hemothorax, as is the case in item d.

Wounds from a sharp object in the chest.

Penetrating injuries or crushes such as gunshot wounds.

Hemothorax caused by blunt chest trauma such as rib fractures is called traumatic hemothorax.

Hemothorax (primary) spontaneous hemothorax secondary to thoracic or systemic disease or iatrogenic coagulation disorder or unknown cause.

Also known as non-traumatic hemothorax.

Hemothorax often occurs at the same time as pneumothorax, called hemopneumothorax.

Hemothorax is common in patients with thoracic trauma.

Bleeding can come from intercostal vessels, intrathoracic vessels, pulmonary lacerations, or trauma to the heart and intrathoracic large vessels.

The number of hemothorax depends on the size of the vascular rupture.

High or low blood pressure and duration of bleeding lasting in lung tissueMost of the bleeding is caused by rib fractures, broken ends, punctures of the pleura and lungs.

Hemothorax refers to the accumulation of whole blood in the pleural cavity, also known as pleural hemopleural hemorrhage, hemopleural cavity. The most common cause is trauma or surgery. Internal medicine is common in empyema and tuberculosis infection, as well as pleural or pulmonary tumors and coagulation disorders.

The clinical manifestations of hemothorax vary depending on the amount and speed of intrapleural blood accumulation and the patient's constitution, and acute blood loss may cause symptoms of hypovolemic shock such as paleness, rapid pulse, shortness of breath, and gradual decrease in blood pressure.