Hemothorax

Japanese: 血胸 - けっきょう（英語表記）Hemothorax

What kind of injury?

A condition in which blood accumulates in the thoracic cavity is called hemothorax. It can cause damage to the heart and large blood vessels, lungs, Battlements ( Today ) Vascular damage ( Internal thoracic artery and vein ( Naikyoudojomyaku ) damage, Intercostal ( Rockan ) Arteriovenous injury) (Figure 38). A condition in which both air and blood accumulate in the thoracic cavity is called a hemopneumothorax, which is seen in cases of lung injury.

What is the cause?

A considerable external force rib cage ( Religion ) This is a type of trauma that occurs when the nerves are affected by the nerves. This includes injuries caused by traffic accidents and falls from heights, as well as Clamping pressure ( Today's heat ) It can also be caused by trauma (trauma from being pinched) or chest bruises from assault. Stab wound ( Seems like ) or Cut ( Work ) It may also be seen in association with.

How symptoms manifest

Intrathoracic after chest trauma Agony ( Kumon ) , chest pain, difficulty breathing, cyanosis (purple color of the skin), facial pallor, Tachycardia ( Confession ) , cold sweats and cold limbs.

Because a large amount of blood can accumulate in the thoracic cavity, massive hemothorax leads to hemorrhagic shock due to a decrease in circulating blood volume, blood pressure drops, and consciousness is impaired, while respiratory failure due to lung collapse (contraction) occurs.

Testing and diagnosis

Hemothorax is diagnosed by physical examination of the chest (inspection, auscultation, palpation, and percussion) and plain chest X-ray. Recently, ultrasound equipment has become available in emergency departments, making it possible to diagnose hemothorax quickly and non-invasively (without injuring the body).

Treatment methods

Thoracic drainage (column) is performed to remove blood accumulated in the thoracic cavity, and the amount of intrathoracic bleeding per hour is measured, while appropriate circulatory management is performed, mainly with fluid infusion and blood transfusion. If there is a large amount of bleeding into the thoracic cavity, emergency thoracotomy surgery may be required to control the bleeding.

Recently, angiography has been used to find the source of bleeding, and once the artery that is the source of bleeding has been identified, Embolism ( Rapid response ) Stopping the bleeding by injecting substances (transcatheter arterial embolization) has also become common.

How to provide first aid

There is no specific first aid for hemothorax. If symptoms of hemorrhagic shock appear, the victim should be placed on his back with the legs elevated to increase blood flow to the brain and heart.

Until the ambulance arrives, it is important to keep the injured person warm by covering them with a blanket or clothing to prevent their body temperature from dropping.

Kunihiro Mashiko

Figure 38 Hemopneumothorax
">

Figure 38 Hemopneumothorax

Hemothorax
(Respiratory diseases)

This is a condition in which bleeding occurs within the thoracic cavity and blood accumulates.

There are two causes: traumatic and non-traumatic. Traumatic causes involve blood vessels in the chest wall, such as the intercostal arteries and internal thoracic arteries, diaphragm ( Oukakuma ) In non-traumatic cases, bleeding occurs when blood vessels in the lungs or the lung parenchyma are damaged. pneumothorax ( Bellflower ) (Because the cord-like tissue attached to the chest wall comes off), malignant tumors, aorta Tumor ( dragon ) Rupture of Pulmonary infarction ( Fast ) The causes include:

When the lung parenchyma is damaged by trauma, Bloody sputum ( Kettan ) or Hemoptysis ( Cutting edge ) If the amount of bleeding is large, the patient may go into shock.

Treatment involves draining the blood through a chest drainage system, and may involve surgery if bleeding continues.

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな外傷か

　胸腔内に血液がたまった状態を血胸といい、心・大血管損傷、肺損傷、胸壁(きょうへき)血管損傷（内胸動静脈(ないきょうどうじょうみゃく)損傷、肋間(ろっかん)動静脈損傷）などに伴ってみられます（図38）。また、胸腔内に空気と血液がともにたまった状態を血気胸といい、肺損傷の際にみられます。

原因は何か

　相当大きな外力が胸郭(きょうかく)に作用した場合にみられる外傷で、交通事故や高所からの墜落はもとより、挟圧(きょうあつ)外傷（はさまれたことによる外傷）や暴行による胸部打撲(だぼく)などによっても発生します。また、胸部の刺創(しそう)や切創(せっそう)に伴ってみられることもあります。

症状の現れ方

　胸部外傷後の胸内苦悶(くもん)、胸痛、呼吸困難、チアノーゼ（皮膚などが紫色になる）、顔面蒼白、頻脈(ひんみゃく)、四肢冷汗および冷感などです。

　胸腔内には大量の血液がたまることが可能なので、大量血胸では、循環血液量の減少による出血性ショックを来し、血圧は低下して意識障害が現れ、同時に肺の虚脱（収縮）に基づく呼吸不全が現れます。

検査と診断

　血胸の診断は、胸部の身体所見（視診、聴診、触診、打診）と胸部単純X線撮影によりなされます。最近では、救急外来に超音波検査装置が常備され、迅速かつ非侵襲的に（体を傷つけることなく）血胸の診断が可能になりました。

治療の方法

　胸腔ドレナージ（コラム）を行って胸腔内にたまった血液を排除し、時間あたりの胸腔内出血量を測定するとともに、輸液、輸血を中心とした適切な循環管理を行います。胸腔内への出血が大量であれば、緊急開胸手術を行って出血を制御する必要もあります。

　最近では、血管造影検査で出血源を探し、出血源となっている動脈が特定できたら、血管内に塞栓(そくせん)物質を注入して止血する方法も一般的になりました（経カテーテル動脈塞栓術）。

応急処置はどうするか

　血胸に対する応急処置はとくにありません。出血性ショックの症状がみられたら、負傷者をあお向けにして下肢を高くし、血液が脳と心臓に少しでも多く供給されるよう努める必要があります。

　救急車が到着するまでの間、体温が低下しないよう、毛布や衣類をかけて、負傷者の保温を図ることも大切です。

益子　邦洋

図38　血気胸
">

図38　血気胸

血胸
(呼吸器の病気)

　胸腔内に出血し、血液がたまった状態をいいます。

　原因には、外傷性と非外傷性があります。外傷性は、肋間動脈、内胸動脈などの胸壁の血管、横隔膜(おうかくまく)の血管、肺実質などが損傷を受けて出血する場合です。非外傷性では、気胸(ききょう)（胸壁と癒着している索状組織がはがれるため）、悪性腫瘍、大動脈瘤(りゅう)の破裂、肺梗塞(はいこうそく)などが原因となります。