weekly_question 6/8/2023

[Admin]

12-year-old boy crashed his motorbike and fractured ribs 4-8 on the left side. A chest tube was placed in the emergency department for a large hemothorax. On post-trauma day 3, the patient remains tachypneic and has a hemothorax occupying half of the pleural cavity. The tip of the chest tube appears within the hemothorax. The most appropriate management strategy is:

A Turning the patient side-to-side every 3 hours for the next two days

B Placement of a second chest tube by Interventional Radiology

C Instillation of alteplase (tPA) into the chest once daily for 3 days

D Drainage of retained hemothorax via Video-Assisted Thoracoscopic Surgery (VATS)

[Admin]

correct answer
D Drainage of retained hemothorax via Video-Assisted Thoracoscopic Surgery (VATS)

This patient has a retained hemothorax. Low quality data from adult trauma patients suggest that a small hemothorax that is not symptomatic or associated with a pneumothorax can possibly be observed without drainage.

This retained hemothorax is large. Adult studies suggest that Video-assisted Thoracoscopic Surgery (VATS) is associated with fewer additional procedures, shorter length of stay, and lower risk of empyema compared thrombolytic therapy. Ideally, VATS should be performed within 4 days of injury.

A second chest tube or position changes are unlikely to be effective in this scenario.

[Ismailmohamed]

B

[Gunduz Aghayev]

D

[Admin]

correct answer
D Drainage of retained hemothorax via Video-Assisted Thoracoscopic Surgery (VATS)

This patient has a retained hemothorax. Low quality data from adult trauma patients suggest that a small hemothorax that is not symptomatic or associated with a pneumothorax can possibly be observed without drainage.

This retained hemothorax is large. Adult studies suggest that Video-assisted Thoracoscopic Surgery (VATS) is associated with fewer additional procedures, shorter length of stay, and lower risk of empyema compared thrombolytic therapy. Ideally, VATS should be performed within 4 days of injury.

A second chest tube or position changes are unlikely to be effective in this scenario.

[Admin]

.