Hemothorax, Pneumothorax, and Patient Positioning


#1

Was wondering if anyone could tell me the pros and cons of transporting a pt with suspected hemo or pneumothorax injured side up vs injured side down. I have heard it taught both ways. Most people tend to agree that the pt should be placed injured side down, however the more I compare the anatomy and pathophysiology, the more I begin to disagree. Mind you, I’m following nationally registered protocols in both scenarios and in both scenarios, the air or blood is only located between the parietal and visceral pleura. Position of comfort is obviously not an option. Can anyone help clarify why it is in fact supposed to be injured side down?


#2

Generally for a patient with a hemothorax the physiologic benefit of injured side down is that blood pooling will help tamponade itself and aeration of the non injured lung will be able to fully expand if up rather than compressed by body weight


#3

I can totally see your point, however I do have a few caveats to that. In reference to a hemothorax, tamponade may not be the best idea just because you want to alleviate the pressure build up in between the visceral pleura and lung. I understand the wound needs to be sealed, however better to seal it yourself and have access to the NCD sites than hope to tampanode the wound and only have access to one site right? When it comes to lung expansion, it’s not as if neither lung will be functional injured side up. A needle-chest decompression should relieve much of that pressure making the injured lung potentially functional or so at least I would think. Idk, I’ve created this word document weighing the pros and cons of injured side up and injured side down. Take a look at it and tell me if I’m missing something please.

Sorry about the messy diagram btw. I had to convert the document into a jpeg and post it on 3 separate posts.


#4


#5