emDocs - Septeber 23, 2016 - Author: Simon E - Edited by: Koyfman A and Long B
The emergency physician’s role in addressing a hemothorax is first to make the diagnosis utilizing CXR, US or CT. Hemothoraces should be managed with the placement of a chest tube to avoid the later complications of empyemas and fibrothorax. Massive hemothoraces warrant volume resuscitation, consultation with a trauma surgeon, and performance of a thoracotomy. Early identification and intervention is the key to limiting the morbitidy and mortality associated with hemothoraces.
- Hemothorax presentation is variable
- Step 1: Diagnose the hemothorax with CXR vs. US definitively with CT
- If the mechanism suggests hemothorax = rule out hemothorax despite CXR findings (CT if patient hemodynamically stable)
- Hemothorax Treatment = Chest tube
- Massive Hemothorax Treatment = Transfuse, consult, thoracotomy PRN
- If the patient is persistently hypotensive despite control of pulmonary bleeding => look for other etiologies
- Auto-transfusion of unprocessed shed hemothorax blood => additional research needed"