An 80-year-old man presents to the emergency department for evaluation of rib pain after he fell off his bike onto his left side earlier in the day. He denies dizziness, lightheadedness, palpitations, or loss of consciousness. Past medical history is significant for prostate cancer and osteoporosis. Current medications include prednisone, alendronate, and calcium, and vitamin D. Family history is significant for osteoporosis in his father and brother. He is an avid runner and cyclist. He does not smoke or use illicit drugs but has a beer occasionally on the weekend. Vital signs are temperature 37.1° C (98.6° F), blood pressure 179/84 mmHg, pulse 87 beats/min, respirations 22/min, and oxygen saturation 96% on 2 liters by nasal canula. Physical examination reveals chest tenderness on palpation of the right anterior chest wall near ribs 7-9 on the left. Incentive spirometry is at 1000 mL. Auscultation of the chest reveals decreased breath sounds on the left lower and middle lung fields. Laboratory studies reveal the following:
Hematocrit: 38% Leukocyte count: 13,000/mm3 Creatinine: 1.0 mg/dLA CT scan of the chest scan shows moderate volume hemothorax. A chest tube is placed and drains500 mL of blood initially and 975 mL more out over the next four hours. Post-placement chest x-ray indicates the chest tube is in position. Which of the following is the next best step in management?
Author(s)
Katie Upton
Editor(s)
Dr. Ted O'Connell
Last updated
Oct 14, 2024
