65.4 Haemothorax and haemopneumothorax

Blood, or blood and air in a patient’s pleural cavity, is the commonest complication of a chest injury. Bleeding can occur slowly over several days, so it is often overlooked, especially if a patient has multiple injuries. Detect it by: (1) Dullness to percussion. (2) Reduced breath sounds. Listen for these by sliding a flat stethoscope under his chest while he is, lying down. (3) A diffuse opacity in an X–ray, which is more clearly seen in an erect film. If there has been much bleeding, he will have all the usual signs of internal bleeding (53.2). He may also be cyanosed. If you don’t remove blood urgently, it will clot, organize, and prevent his lung re-expanding. When this happens, it can only be made to expand again by decorticating it at thoracotomy. So make sure you diagnose haemothoraces, drain them immediatly, and keep a patient’s injured pleura drained. Removing blood also removes the danger of leaving a fluid medium in his chest which may become infected.