Hemothorax-Blunt Trauma

Algorithm

1. Minimal (500 ml or less)
   • Observe
     • No progression
       • Repeat film
       • Clearing
       • No treatment
     • Increasing hemothorax
       • Chest tube
         • Bleeding stops. Clearing and no further treatment
         • Continued bleeding exceeding 1000 mL requires thoracotomy
2. Moderate (300 - 800 mL)
   • Chest tube
     • Bleeding stops
       • Clearing and no further treatment
       • Persistent hemothorax requires thoracotomy
     • Continued bleeding requires thoracotomy
3. Major (more than 1000 mL)
   • Opacified hemothorax
   • Over 1000 mL immediate loss
   • Unstable patient not responding to volume
   • Continued loss
     • > 100 mL/hr after 6 - 8 hours - thoracotomy
     • or loss > 200 mL/hr after 2 - 4 hours] - thoracotomy
4. Findings that require arteriography regardless of state or volume of hemothorax.
5. Widened mediastinum
6. First rib fracture with pulse deficit, neurological deficit, or expanding hematoma.

From Hood RM: Surgical Diseases of the Pleua and Chest Wall. Philadelphia. WB Saunders Co. 1986, p 222.