Lab Case 209 – Interpretation

Critically unwell 59 year old returned traveller with shock and uncertain cause.

CXR reveals large pleural effusion (Radiology case of the week) – which was a haemothorax.

Features on bloods of sepsis, severe acute renal failure and DIC

requiring resuscitation, chest drainCourse of events:

Chest drain inserted left chest – frank blood, hypotension worsened. Tube clamped after 1 litre blood drained in 30 seconds.

Consultant called – resuscitation improved upon, intubated, inotropes, chest drained 3.5 litres blood.

ICU involved – admitted – CT abdomen showed large renal cell cancer with extension into IVC and rt atrium. Patient palliated the next day.

Learning points regarding chest drains:

If there is bleeding in the chest, clamping the drain just means that the blood collects in the chest cavity rather than where you can assess the amount of bleeding (unless you put the drain in the left ventricle).

If you are checking a coagulation profile because you think it is necessary wait for the result unless the patient is peri arrest due to his chest problem

Resuscitate the patient

Insert a small bore drain if you think there is a bleeding risk