Curriculum · Respiratory
Massive haemothorax
What it is
Massive haemothorax is one of the life-threatening injuries the primary survey exists to find and treat. It carries two definitions side by side: an initial blood loss above 1.5 L, or a continuing blood loss above a set rate, with the rate given as more than 250 ml/hr over the first 4 hours in one place and as more than 200 cc/h for 2 to 4 hours through the drain in another. A hemodynamically abnormal patient is part of it. It is also put as the rapid accumulation of more than 1500 mL of blood, or one-third or more of the patient's blood volume, in the chest cavity.
How it presents
On the breathing part of the primary survey, one side of the chest shows no expansion and no air entry, with distended neck veins and the trachea deviated away. The same set of signs is found in tension pneumothorax, and the two are given as the ddx of each other. The set of shock, tracheal deviation away, dullness in percussion and reduced air entry in auscultation is written under tension pneumothorax, not under massive haemothorax, which is left with no signs of its own on that list. What is checked on breathing is the oxygen saturation, the chest movement, normally bilateral and symmetrical, and the chest on auscultation for decreased air entry.