14. A 30-year-old man presents to the resuscitatio - highsky

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14. A 30-year-old man presents to the resuscitation
bay with gunshot wounds in the anterior and
posterior left chest. Although in distress and
dyspneic, the patient is cooperative. He has a
patent airway and is moving all extremities.
His pulse is 120/min, blood pressure is 120/90
mm Hg, and respiratory rate is 30/min. He has
bounding distal pulses, and no other injuries
are identified on secondary examination. X-ray
of the chest reveals fluid in the pleural space,
and a left chest tube thoracostomy yields 600
mL of bright red fluid. Over the next hour,
750 mL of blood is collected. What is the most
appropriate next step in management?
(A) Autotransfuse with the collected blood and
continue to observe closely
(B) Insert another chest tube
© Left thoracotomy
(D) Remove the chest tube and suture the incision
closed
(E) Thoracentesis

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[ArchivalUser]

14. The correct answer is C. Patients with a hemothorax
that is bleeding at a rate > 200 mL/h
require an urgent thoracotomy to control the
hemorrhage. It is likely that the internal thoracic
and/or intercostal arteries are lacerated.
Answer A is incorrect. Hemothoraces that are
less severe (< 200 mL/h) can be treated with
autotransfusion of the collected blood.
Answer B is incorrect. Inserting another chest
tube will not help control the bleeding, which
is the priority.
Answer D is incorrect. Removing the chest
tube will not correct the source of bleeding,
and the patient is at risk for exsanguinating.
Answer E is incorrect. Thoracentesis is used
for diagnosis when the etiology of pleural fluid
is uncertain. In the setting of a gunshot wound
and bright red fluid in the pleural space, hemothorax
is highly suspected, and urgent attention
is needed due to the extent of bleeding.