Type of Injury
Human beings are vulnerable to seral body injuries. Some of them may be severe when treated, while others may recover without much challenges. One of the injuries that are considered critical to human life is the hemothorax. According to Staub et al. (2018), hemothorax is a traumatic thoracic injury in which blood collects between the lungs and the chest wall. Also known as the pleural cavity or denoted as the space between the parietal pleura and visceral. In this type of injury, the blood collects and builds up in the cavity resulting in the collapse of lungs. Once the blood builds up in the lungs, it is pushed outside, leading to bleeding in the thorax. The bleeding may arise from the abdomen, internal or intercostal mammary arteries, diaphragm, lung parenchyma, myocardium, mediastinum, great vessels, or chest wall.
Mechanisms
Injuries do not occur on their own, but several factors cause them. While there are several causes of hemothorax, chest trauma is, however, considered the most common cause. It happens when human body experiences intense and sudden impact like hitting the chest hard, getting in a car accident, or falling hard at the forefront of the body. According to Gonzalez et al. (2020), chest trauma injuries range from contusion of thoracic wall to flail chest, cardiac tamponade, laceration, and pneumothorax (PTX). Hemothorax is caused by pleura cancer (Pleural mesothelioma), lung-related metastatic cancer such as colon cancer and breast cancer, and chest surgery, mostly heart and lung surgery. It is also caused by lung infections like tuberculosis, bleeding disorder that may result in the excess dosage of blood inners and prolonged clotting, spontaneous, pulmonary infarcts, and embolism (Yap, Chaudhury, & Mbakada, 2018). Defects in blood clotting, such as hemophilia or anticoagulant drugs and tears in blood vessels, especially in the lungs, are also related causes of hemothorax. Placing a venous catheter, which acts as a medical procedure, can also cause hemothorax.
Signs and symptoms
To distinguish hemothorax from other conditions, there are several signs and symptoms that the doctors observe. They are unique, and they include anxiety, extreme restlessness, and severe shortness of breath. Doctors can also assess shock body characteristics such as becoming weak, low blood pressure, cold extremities, and rapid heart rate, which are signs and symptoms of the injury (Gonzalez et al., 2020). Chest pain with deep and sharp breathing and varying with position is another key characteristic of the injury. Other significant signs and symptoms of the injury include high fever over 1000F (380C), skin turning pale, and also a feeling of impending doom.
Treatment and Care
When the victims are taken to the emergency room, they are initially treated with emergency tools such as ventilators. A tube is inserted into the nose penetrating through the windpipe to the chest cavity, where the blood is pooled. The piping provides enough oxygen hence supporting breathing. The main treatment of the injury is to drain the pooling blood from the cavity. To drain the blood, fluid, or air, a tube is inserted through the ribs, chest muscles, and tissues into the chest cavity. If the lungs have collapsed, the tube may remain inserted for several days for the lungs to expand again (Staub et al., 2018). However, if the bleeding continues, long-term care may be needed in which chest surgery may be recommended. Also known as thoracotomy, chest surgery is done based on the part of the chest operation part. Once the surgery is complete, the tube must remain inserted in the chest cavity to drain the remaining fluid or blood.
Referral
Once the patients have been assumed to have hemothorax injury, they should be referred for further diagnosis and treatment. When considered to have an acute or severe injury, the patients should be referred to Emergency Service for initial resuscitation before being referred to Surgical Service. General Surgical Services could manage moderate or minor trauma issues like hemopneumothorax. However, if the chest trauma is severe, it may require a referral to the Thoracic Surgery Service (Yap, Chaudhury, & Mbakada, 2018). In this case, it is deemed essential for telephone communication to Thoracic Service. Further, once the post-surgical chest encounters some challenges, it is considered to refer the patient back to the original treating surgeon. Suppose the doctor suspects that the EDS, tuberculosis, cancer, or other underlying conditions cause the injury. In that case, further referral to image or blood testing may be recommended for better diagnosis and treatment.
Rehabilitation
Rehabilitation for people with hemothorax injury involves the physiotherapist identifying what training or therapy should be recruited to help them restore their conditions. The rehabilitation for the patients who have surgery might differ from when the patients have the intercostal drain in and the chest tube inserted. One of the rehabilitation approaches is through the breathing exercise technique to help re-inflate atelectatic lung areas, improve oxygenation, and improve ventilation. Assisting patients with general strengthening exercises or mobilization can help improve mobility and exercise tolerance (Gonzalez et al., 2020). It could also be considered vital to helping the patients clear any secretions by showing them the assisted coughing technique. The assisted coughing technique helps maintain airway clearance hence improving breathing among the patients.