Hemothorax occurs when blood accumulates in the pleural space, the area between the lungs and chest wall. Thos is generally caused by blunt force trauma, over pressure, or puncture that causes vascular damage. Symptoms can vary depending on the severity of the bleeding, but may include: 

• Shortness of breath: This is the most common symptom, as the blood accumulation reduces lung capacity. When you listen for breath sounds you may find them diminished on the affected side or even absent. 

• Chest pain: Pain may be sharp, stabbing, or dull, and can worsen with breathing. 


• Cough: A cough may produce bloody or frothy sputum. 


• Dyspnea on exertion: Difficulty breathing. This is due to the lung space that is normally taken up by air is now getting replaced with blood. The lung can't expand properly and have less volume. Oxygen and Carbon Dioxide exchange is not happening as it should. Can't oxygenate, can't ventilate causing the Hypercarbia and Hypoxia.


• Rapid heart rate and breathing: The body tries to compensate for the reduced oxygen levels. The heart has to beat faster to make up for the lack of volume. The heart is preload dependent and if the pressure builds up in the chest it will push on the Vena Cava choking off the blood return to the heart. If the heart can't get the blood in to fill it then it will not pump it out. This leaves your patient hemodynamically unstable. The blood filling lung becomes take the place of the air and the lung can't expand. As pressure builds you will lose your ability to oxygenate and ventilate your patient. The pressure on the Vena Cava will build and late signs are JVD and Tracheal Deviation. 


• Low blood pressure: Blood loss can lead to hypotension. As you lose blood from the vascular system the heart also has to speed up to compensate for the volume loss. 


• Pale, cool, and clammy skin: This indicates poor circulation. The body is shunting the blood to the vital organs and your patient is showing signs of shock. Shock is inadequate tissue perfusion at the cellular level. 


• Confusion or anxiety: In severe cases, blood loss can affect brain function. Your patient is not perfusing the brain, and your patient is in shock. The hearts inability to properly pump due to the lose of preload and vascular volume will affect the blood pressure. Now add the hypoxia and hypercarbia to the mix and you have H Bombs killing your patient. Hypotension, Hypercarbia, Hypoxia are just a few of the many you need be aware and know how to treat. 

• Fever: If the blood becomes infected. 

Other Symptoms: 

nausea, vomiting, and fatigue

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Hemothorax, a condition where blood accumulates in the pleural space between the lungs and chest wall, requires prompt medical attention. Treatment aims to stop bleeding, remove accumulated blood, and restore lung function. 

Initial Management:
Stabilize vital signs, Administer oxygen and monitor oxygen saturation, Perform chest X-ray or ultrasound to confirm diagnosis, and Control bleeding with chest tube placement. 

Blood Removal: 

• Thoracentesis (needle aspiration): Used for small amounts of blood 
• Finger Thoracostomy: an emergency procedure that can be used to treat hemothorax and tension pneumothorax
  

• Chest tube insertion: For larger volumes of blood 
• Surgical intervention: May be necessary if bleeding is uncontrolled or a chest tube is ineffective 

Other Interventions: 

• Blood transfusions: To replace lost blood

• Antibiotics: If infection is suspected

• Pain management: To alleviate discomfort

• Observation: Monitor for complications such as infection, pneumonia, and lung collapse 

Follow-Up Care: 

• Regular chest X-rays to monitor blood drainage

• Removal of the chest tube when drainage ceases

• Observation for signs of infection or other complications

• Pulmonary rehabilitation: To restore lung function 

Specific Treatment Options: 

• Video-assisted thoracic surgery (VATS): A minimally invasive surgical procedure to remove blood clots and repair bleeding vessels. 
• Thoracotomy: An open chest surgery to access the pleural space directly and stop bleeding. 
• Intrapleural fibrinolytic therapy (IPFT): A medication injected into the pleural space to dissolve blood clots. 

It's important to note that the specific treatment plan for hemothorax will vary depending on the severity of the condition, the underlying cause, and the patient's overall health. Consult with a healthcare professional for proper diagnosis and treatment recommendations.

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Tranexamic acid (TXA) is an antifibrinolytic drug that can be used to reduce bleeding and the risk of death in trauma patients: 

• How it works
  TXA reduces blood loss by preventing the breakdown of fibrin, which helps stabilize blood as it clots.

• When to use it
  TXA is most effective when given within the first hour after injury but should be given within 3 hours. If given after 3 hours, there is a higher risk of death from bleeding. 


• Who to use it for
  TXA should be given to all trauma patients who are at risk of bleeding-related death, including those who need a blood transfusion. It's safe to administer to a wide range of patients and shouldn't be restricted to the most severely injured. 


• How to administer it
  A typical dose is 2g of TXA given slow bolus, 


• Benefits
  TXA has been shown to reduce mortality in trauma patients and can also reduce the need for blood transfusions. 


• Safety
  TXA is generally considered safe, with no serious side effects. 




• Pre-hospital administration of TXA is becoming more common and can be given by trained emergency personnel prehospital.

Find this and more in the training provided by www.911tacmed.com on the training calendar. Just scroll down for the list of courses and dates.

When evaluating a burn patient in the ER, common laboratory tests include a
complete blood count (CBC), electrolytes, blood urea nitrogen (BUN), creatinine, glucose, coagulation profile (PT/PTT), arterial blood gas (ABG), and sometimes a carboxyhemoglobin level to assess for smoke inhalation,
all aimed at monitoring fluid balance, electrolyte abnormalities, kidney function, and potential complications related to the burn severity. 
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Key points about burn patient lab tests

• CBC:
  Checks for anemia or infection by evaluating red and white blood cell counts. 

• Electrolytes:
  Monitors sodium, potassium, and other electrolytes which can be significantly altered due to fluid shifts caused by burns. 
• BUN and Creatinine:
  Assesses kidney function, important for monitoring fluid resuscitation in severe burns. 
• Coagulation profile:
  Checks for potential bleeding issues like disseminated intravascular coagulation (DIC) which can occur in severe burns. 
• ABG:
  Measures blood oxygen and carbon dioxide levels, especially crucial for patients with smoke inhalation injuries. 
• Carboxyhemoglobin level:
  Specifically detects carbon monoxide poisoning from smoke inhalation. 

          Factors influencing specific lab tests:

• Burn severity:
  More extensive burns may require more frequent and comprehensive lab monitoring. 

• Type of burn:
  Chemical burns might require additional tests to assess specific toxins involved. 
• Patient's medical history:
  Existing conditions like diabetes or heart disease could necessitate additional lab monitoring.