Critical Care Medicine-Pulmonary Disorders>>>>>Pleural Disorders
Question 5#

A 90-year-old female with a history of atrial fibrillation on Eliquis presents with right rib pain and dyspnea after a mechanical fall from standing. She is hemodynamically stable, but her chest CT reveals right rib fractures 3 to 5 with associated hemothorax.

The next best step in management includes:

A. Placement of a large bore chest tube for hemothorax evacuation
B. Placement of an epidural for pain control and prevention of respiratory decompensation
C. Consult thoracic surgery for emergent VATS
D. Initation of broad spectrum antibiotics

Correct Answer is A

Comment:

Correct Answer: A

Prompt drainage of a hemothorax addresses treatment before the development of clot. Retained hemothorax carries the risk of empyema. An epidural would not be appropriate at this time as the patient has been on anticoagulation. A consult to thoracic surgery may eventually be required if the initial output is greater than 1.5 L or the patient develops a retained hemothorax, but it is not emergently necessary in a hemodynamically stable patient. Prophylactic antibiotics are indicated in the first 24 hours after chest tube placement for a hemothorax; however, broad spectrum antibiotics would not be necessary at this time. 

Reference:

1. Boersma WG, Stigt JA, Smit HJM. Treatment of haemothorax. Respir Med. 2010;104(11):1583- 1587.