Critical Care Time 29. Pleural Disease Part 2: Hemothorax & BPF with Dr. Michal Sobieszczyk, MD
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Jul 15, 2024 Dr. Michal Sobieszczyk discusses hemothorax & bronchopleural fistulas. Small vs large chest tubes, endobronchial valves for air leaks, and managing pleural diseases are covered in detail. Insightful discussion on patient management and treatment options.
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Small Tubes Often Sufficient for Hemothorax
- Small bore chest tubes (around 14-15 French) are often sufficient for hemothorax drainage if the patient is stable.
- Large-bore tubes have higher complication risks and are usually reserved for unstable patients or extensive bleeding.
Fresh vs Old Blood Test Anecdote
- Dr. Sobieszczyk shares a bedside test from Africa to differentiate fresh from old blood in a pleural effusion.
- Fresh blood will clot when squirted onto a dressing, while old blood will not due to depletion of clotting factors.
Manage Incomplete Hemothorax Drainage
- For incompletely drained hemothorax, consult thoracic surgery early and consider additional chest tubes, fibrinolytic therapy, or VATS.
- Leaving >300cc blood in the chest risks empyema or fibrothorax, leading to serious long-term complications.