II. Causes: Chest Traumatic Injury
- Lung Laceration
- Intercostal artery vessel injury
- Internal mammary vessel injury
- Thoracic Vertebral Fracture
III. Precautions
- Color of blood recovered from Hemothorax does not reliably differentiate arterial from venous source
IV. Management: Small Hemothorax (<300 cc)
- Size cutoff for small Hemothorax: 300 cc
- Evaluation by CT Chest
- XRay is inadequate to estimate Hemothorax size
- Calculation
- Estimate area of Hemothorax on an individual CT slice
- Multiply by the CT slice thickness
- Mulitply by the number of slices in which the Hemothorax appears
- Indications for standard Chest Tube drainage of small Hemothorax
- Symptomatic patient
- Subacute Hemothorax (cut-off for drainage is lower than standard 300 cc cutoff)
- Suspected superinfection of Hemothorax (empyema)
- Indications for small Pigtail Chest Catheter (8-16 french)
- Consider for a borderline size Hemothorax in an otherwise well patient
- Indications for observation of small Hemothorax
- Healthy asymptomatic patient
- Complications of an undrained small Hemothorax (uncommon)
- Retained Hemothorax
- Empyema (superinfected Hemothorax)
- Fibrothorax (lung trapped in Hemothorax)
- References
- Inaba in Majoewsky (2012) EM:Rap 12(11): 1
V. Management: Massive Hemothorax (>1500 ml or one third Blood Volume)
- Consider Autotransfusion device (e.g. hemovac, cell saver)
- Large bore Chest Tube (36-40 french) at the 5th intercostal space in the midaxillary line
- Operative management as below
VI. Precautions: Indications for operative management (thoracotomy)
- Chest Tube output >1500-2000 cc total or
- Chest Tube output 150-200 cc/hour for several hours or
- Refractory hemodynamic instability or
- Penetrating anterior Chest Trauma medial to the nipple line