What in included in emergency department (ED) care for hemothorax?

Updated: Jul 13, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Jeffrey C Milliken, MD  more...
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Initial treatment is directed toward cardiopulmonary stabilization and evacuation of the pleural blood collection. The patient should be sitting upright unless other injuries contraindicate this position. Administer oxygen and reassess airway, breathing, and circulation. Obtain an upright chest radiograph as quickly as possible.

If the patient is hypotensive, establish a large-bore intravenous line. Immediately commence appropriate fluid resuscitation (eg, with 20 mL/kg of lactated Ringer solution), including blood transfusion as necessary.

Evaluate for the possibility of tension pneumothorax. Needle decompression of a tension pneumothorax may be necessary.

The need for a chest tube in an asymptomatic patient is unclear, but if the patient has any respiratory distress, perform thoracostomy. If a conventional chest tube is not removing the blood collection, further steps may be necessary. Conventional treatment involves placement of a second thoracostomy tube. However, in many patients, this therapy is ineffective, necessitating further intervention.

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