injuries poisoning
Hemothorax
Treatment of Hemothorax
Fluid resuscitation as needed Usually tube thoracostomy Sometimes thoracotomy Patients with signs of hypovolemia (eg, tachycardia, hypotension) are given IV crystalloid and sometimes blood transfusion (see Intravenous Fluid Resuscitation ). If blood volume is sufficient to be visible on chest x-ray (usually requiring about 500 mL), or if Pneumothorax is present, a large-caliber (eg, 28 to 38 Fr) chest tube is inserted in the 5th or 6th intercostal space in the midaxillary line. Tube drainage improves ventilation, decreases risk of clotted hemothorax (which can lead to empyema or fibrothorax), and facilitates assessment of ongoing blood loss and diaphragmatic integrity. Blood collected via tube thoracostomy can be autotransfused, decreasing the requirement for crystalloid and exogenous blood. Urgent thoracotomy is indicated in either of the following situations: Initial bleeding is>1500 mL Bleeding is>200 mL/hour for>2 to 4 hours and causes respiratory or hemodynamic compromise or the need for repeated blood transfusions. 