FAQ - Hemopneumothorax
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Hemopneumothorax.?


I need detailed information about hemopnemothorax.I can't seem to find any helpful website on the matter, surprisingly. Hope anyone can help. The info that I need include the pathophysiology, signs and symptoms , diagnosis, treatment and management, complications, and how it affects respiration. Your answers would really be a great help.
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Hemopneumothorax is a medical term describing the combination of two conditions: pneumothorax, or air in the chest cavity, and hemothorax (also called hæmothorax), or blood in the chest cavity.

The resulting condition is a serious state wherein respiration is repressed. The blood and air fill the pleural space, the space between the lung and the chest wall, putting pressure on the lung. This can cause the lung to collapse and be unable to fill with air (unilateral hemopneumothorax). In the most serious of cases, both lungs may collapse (bilateral hemopneumothorax). Death follows if respiration is inhibited enough.

Treatment

Treatment for this condition is exactly the same as for its separate states, by tube thoracostomy—the insertion of a chest drain through an incision made between the ribs, into the intercostal space.

Commonly, surgery is needed to close off whatever injuries caused the bleeding into the lung cavity and also whatever injuries caused the air to enter the cavity (e.g stabbing, broken ribs, etc.)catamenial pneumothorax
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Catamenial pneumothorax is a condition of collapsed lung occurring in conjunction with menstrual periods (catamenial refers to menstruation), believed to be caused primarily by endometriosis of the pleura (the membrane surrounding the lung).[1]

Classification

Catamenial Pneumothorax is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations.

Symptoms and signs

Onset of lung collapse is less than 72 hours after menstruation. Typically, it occurs in women aged 30-40 years, but has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis.

Pathophysiology

Endometriosis can attach to the lung, forming chocolate-like cysts. Generally the parietal pleura is involved, but the lung itself, the visceral layer, the diaphragm, and more rarely the tracheobronchial tree may also be afflicted[2] . How this endometrial tissue reaches the thorax remains enigmatic, although defects in the diaphragm can often be found.[3]

The cysts can release blood; the endometrial cyst "menstruates" in the lung. Air can move in by an unknown mechanism. The blood and air cause the lung to collapse (i.e. catamenial hemopneumothorax).[4]

Diagnosis

Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. CA-125 is elevated. Nowadays, video-assisted thoracoscopy is used for confirmation.

Treatment

Pneumothorax is a medical emergency because it comes with severe pain and decreased lung function. A chest tube should be inserted after clinical assessment. This releases the air and menstrual blood, and the lung can re-expand.

Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome.[5] Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst.[6] Pleurodesis may also be helpful. Menstruation and accompanying lung collapse can be suppressed with hormone therapy,[7] like with Lupron Depot, danazol or extended cycle combined oral contraceptive pills.  (+ info)

how long after trauma[stabbing] will a hemopneumothorax occur? If treated right away can it be prevented?


Can it be avoided if help is received quickly as opposed to 8 hrs later?
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It depends on what structure are hit, how extensive the wound is, the thickness of the cut, etc. If an ice pick or stilleto is use, then it may take a long time for a hemopneumothorax sufficinet to cause repiratory and cardiac complications to devlop. (I think that that is what you are really asking.) A large Bowie-type knive, will cause more extensive injury and the complications will develop more rapidly. Think of it this way. A deer is shot in the chest. That will certainly cause a hemopneumothorax. And yet, the deer can run for miles before it finally dies.

It's not the hemopneumothorax itself that necessarily causes death. If the lining of the heart is cut, bleeding into the pericardium (hemopericarium) can occur and, if sufficient blood enters, can prevent the heart from fully filling with blood (cardiac tamponade) and so the patient dies of lack of blood being pumped. If enough air in released into one side of the chest, it too can expand and push the entire heart-lung complex to one side of the chest. In that case, the vena cavae (the veins that return blood to the heart) become kinked like a garden hose. No blood into the heart; no blood out of the heart. Once again the patient dies because of lack of blood BEING PUMPED. (There may be plenty of blood left in the body, but it's going nowhere.

The treatment is to insert a chest tube into the pleural cavity and drain the AIR that's causing the tension pneumothorax. The blood, of course, will also come out. Then, a chest surgeon will need to assess the patient to see if he will need more definitive surgical care.  (+ info)

Pl information about the PATHOFISIOLOGY mechanism causing respiratory arrest in patien with hemopneumothorax?


i need only this details - pathofosiology mechanism of respirathory arrest in patients with haemipneumothorax
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Haemopneumothorax can cause compression of the cardiac and respiratory vessels leading to impaired gaseous exchange, as well as infiltration of interstitial fluid caused by trauma, into the alveoli-making them incapable of proper function.Carbon dioxide builds up in the blood and impairs the respiratory centres of the brain which control the rate and depth of breathing- therefore further complicating the picture.  (+ info)

what nursing diagnosis is appropriate for hemopneumothorax?


Pain, Inadequate oxygenation, decreased mobility, oxygen therapy. Just a few, hope it helps.  (+ info)

What is the total cost of a thoracotomy procedure?


Lets say the patient got into a car accident and was diagnosed to having a hemopneumothorax. Approximately, how much would a thoracotomy procedure cost to stop the bleeding?
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No set amount can be assessed. This depends on the hospital, and doctors, whose fees are NOT fixed, and also on how long you are in the hospital. A good guess is this incident may cost you a couple of grand at the very least before it is resolved.  (+ info)

Is it safe for a Pneumothorax patient to travel by air?


Patients condition - Hemopneumothorax ( Blood in the lungs ), how long does it take to heal and when can the patient travel by air?

Will there be any problems with the patient due to the high altitude and decompression?

Thanks in advance.
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Call the patient's doctor and ask. Even if a doctor answers on these boards, he/she does not know this patient's situation and is not able to give you an answer that addressed that particular patient's needs.  (+ info)

Blunt/Penetrating trauma to the Thorax?


Im looking for a simple outline of some of the common injuries from blunt/penetrating trauma. Simple pneumothorax, open pneumothorax, tension pneumothorax, hemothorax, hemopneumothorax, pulmonary contusion, pericardial tamponade, myocardial contusion, flail chest(paradoxical motion)? I know that is a lot but I would just like a simple outline of a good way to retain these chest injuries. Thanks!
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Pneumothorax
Accumulation of air in the pleural space may compromise respiration by interfering with the expansion of the lung. Respiratory distress usually is not seen until the pneumothorax exceeds 40% of one lung’s volume, unless the patient has lung disease or injury. Pneumothorax is usually due to blunt rupture of the lung surface, rather than laceration by broken ribs. Breath sounds are decreased on the affected side. Pain may not develop for hours. If the pneumothorax is large, hyperresonance to percussion may be present. Diagnose pneumothorax from chest x-ray by observing a pleural stripe that has fallen away from the chest wall, with absence of lung markings beyond the stripe. Evacuate the pneumothorax by chest tube insertion.

Open pneumothorax AKA sucking chest wound
An open wound allows air to be sucked into the chest with inspiration. If large enough, it may interfere with air motion in the lungs by decreasing the amount of negative pressure that can be generated during inspiration. Small wounds can form one-way valves, leading to tension pneumothorax. An open chest wound will exhibit some unusual motion during respiration. This can usually be heard and felt. The diagnosis is made on clinical inspection of the wound. The wound should be covered with a dressing. Tape the dressing on three sides, so it can act as a one-valve allowing air to exit the chest with expiration, but preventing sucking-in during inspiration. A chest tube should be placed at a second site.

Hemothorax
Blood in the chest is usually due to lung injury. In these cases it will usually be mild. Massive hemothorax is most often due to bleeding from the major central chest vessels. Breath sounds will usually be decreased on the affected side. Hemothorax should be suspected on finding unilateral decreased breath sounds and dullness to percussion. Chest x-ray may confirm the diagnosis. Up to a liter of blood may be present, and not seen, on a chest x-ray. Remove the blood of a hemothorax by chest tube, even if the blood accumulation is not enough to interfere with respiration. Placement of a chest tube also serves to tamponade bleeding by bringing the lung surface up against the chest wall. The tube must be large (36-40), and should be aimed posteriorly. Most cases of hemothorax do not require operation unless bleeding continues.

Hemopneumothorax
A combination of air and blood in the pleural space. Basically the same symptoms, diagnosis and treatment as pneumothorax and hemothorax.

Tension pneumothorax
Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this 'one-way-valve' effect. Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest. The classic signs of a tension pneumothorax are deviation of the trachea away from the side with the tension, a hyper-expanded chest, an increased percussion note and a hyper-expanded chest that moves little with respiration.The central venous pressure may be raised. The patient may be tachycardic, tachypnoeic, or hypoxic. These signs are followed by circulatory collapse with hypotension and subsequent traumatic arrest with PEA. Classical management of tension pneumothorax is emergent chest decompression with needle thoracostomy. A 14-16G intravenous cannula is inserted into the second rib space in the mid-clavicular line. The needle is advanced until air can be aspirated into a syringe connected to the needle. The needle is withdrawn and the cannula is left open to air. Chest tube placement is the definitive treatment of traumatic pneumothorax. The controlled placement of a chest tube is preferable to blind needle thoracostomy.

Pulmonary contusion
Bruising of the lung results from passage of a shock wave through the tissue. Rales will often be heard. The chest x-ray shows opacity in the peripheral lung near to the injured chest wall. The chest x-ray may lag 12-24 hours behind the clinical extent of the contusion. Blood gases will tend to worsen for two or three days as edema increases in the lung. Stiffness of the lung causes dyspnea and elevated respiratory rate. The diagnosis is made when parenchymal infiltrate is seen adjacent to injured chest wall. Pulmonary contusion may exist, however, despite a normal x-ray. Treat milder cases with oxygen and observation. If respiratory distress is present, intubation and mechanical ventilation are beneficial while the lung recovers. Be aggressive in treating patients who have pulmonary contusion combined with severe abdominal injuries or COPD.

Pericardial Tamponade
Pericardial blood is usually due to penetrating injuries of the heart. In those cases that are not rapidly fatal, the pericardium may  (+ info)

Does this scenario causing chest trauma make sense?


Let's say someone is playing football when tackled by two offensive players. The force causes him to break two ribs on the left side. One of the ribs penetrate the lung which causes a pulmonary laceration and hemopneumothorax. The hemopneumothorax causes his left lung to collapse, hemoptysis (coughing blood), severe pain, rapid breathing and heart rate, and hypoxia which causes loss of consciousness and a coma. He also has a small pulmonary contusion on the right lung, a severe concussion, a dislocated shoulder and a large hemotoma covering his left side.

Does this scenario make sense or am I missing some elements? It is for a story I am beginning and I need to ensure the accuracy of this incident.

Thanks so much, I appreciate the help.
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See, most people know CPR (i.e. watching the football game) and would start rescue breathing before the boy went for < 2 minutes without breathing (coma threshold). Plus, medical personnel are usually always at football games, and coaches are required to be certified the in the aforementioned CPR procedure. So I would have trouble with this story unless they were not at practice or a game (like in the woods or something). Also, the hematoma is over the top. Severe bruise at most.  (+ info)

Does this football injury make sense with this scenario?


Let's say that someone is playing football and ends up getting tackled with enough force to cause two broken ribs, a dislocated shoulder, and a severe concussion.

Let's say that as a result of two broken ribs, the lung on the left side gets penetrated causing a pulmonary laceration.
The pulmonary laceration causes a hemopneumothorax, which causes severe breathing complications. The person would be coughing blood as a result of the hemothorax and wouldn't be able to breath properly because of the collapsed lung caused by the pneumothorax.

Since the person isn't getting proper oxygen, they would suffer from hypoxia and loss consciousness after several minutes.

Does this all make sense and what would be the course of action at a high school football practice?
Let's say one of the other plays decides to give CPR and oxygenate the person while the ambulance is arriving. When the ambulance arrives they would insert an endotracheal tube to help the the person breath until they get to the hospital, where they would insert a chest tube to reinflate the collapsed lung.


Does this make sense, and if not, how could I correct it?
I know I have already asked this, but I didn't get much feedback. I am hoping more people will be on and able to answer this question.
I need to know if it at all possible, I am using this idea for my story.
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A hemopneumothorax just means you have blood in the chest cavity- not necessarily the lungs. Most folks actually don't cough up blood, although they will have a lot of difficulty breathing and their chest will most certainly hurt. It often takes an x-ray to actually determine if there is bleeding in the chest cavity. You can't give CPR to a person with a beating heart, nor would you need to do artificial respiration, because they are still breathing. Doing so would also not increase the amount of oxygen taken in, because you breathe out less oxygen than the person would be able to breathe in on their own. The person is actually not likely to lose consciousness because of the injuries you describe. If they did, then the EMT's would likely insert an endotracheal tube if they were qualified to do so. Otherwise, if the person were conscious, what he'd likely get is a mask or nasal canula to provide oxygen in transport. Once in the hospital, x-rays would determine the extent of the damage and bleeding, and a call would be made to do surgery afterwere initial treatment with tube thoracostomy or thoracocentesis. Losing the left lung actually isn't as dramatic as you would think either- and it's unlikely the entire lung would actually collapse that quickly. The left lung is your smallest lung, since you need the room for your heart. Your right lung would stay inflated, since your patient has no open wound. It would be best to lay the person on their left side, and simply let them breath until the ambulance arrived. Of course that would also depend on the condition of the dislocated shoulder, and which side that was on. At first, the person would be more likely to complain of that pain than the chest. Some of your story is plausible, some is not. Football players usually don't get concussed that badly, as they wear helmets which provide protection. The ribs are also pretty tough characters, and to puncture a lung, you would most likely need to have more than two broken and displaced. In that case, you would also more likely have an injury to the spleen than the lung too. I've never seen a hemopneumothorax as a result of a football injury, but I have seen plenty of liver and spleen lacerations. Those are not quite as immediately dramatic, but more likely.  (+ info)

Does this football injury make sense with this scenario?


Let's say that someone is playing football and ends up getting tackled with enough force to cause two broken ribs, a dislocated shoulder, and a severe concussion.

Let's say that as a result of two broken ribs, the lung on the left side gets penetrated causing a pulmonary laceration.
The pulmonary laceration causes a hemopneumothorax, which causes severe breathing complications. The person would be coughing blood as a result of the hemothorax and wouldn't be able to breath properly because of the collapsed lung caused by the pneumothorax.

Since the person isn't getting proper oxygen, they would suffer from hypoxia and loss consciousness after several minutes.

Does this all make sense and what would be the course of action at a high school football practice?
Let's say one of the other plays decides to give CPR and oxygenate the person while the ambulance is arriving. When the ambulance arrives they would insert an endotracheal tube to help the the person breath until they get to the hospital, where they would insert a chest tube to reinflate the collapsed lung.


Does this make sense, and if not, how could I correct it?
Thanks so much. :)
Is it POSSIBLE that this scenario could occur in football, though? Even if it is like a one-time freak accident? Is it remotely legit?
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Sounds more like he got hit by a car.  (+ info)


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