Fig 11. Haemothorax on a supine
Common, typically caused by intercostal vessel injury (high arterial pressure system, and therefore potentially brisk bleeding) or more rarely, lung laceration (low arterial pressure system).
Two errors in CXR interpretation:
Treatment
If a haemothorax is large enough to be visible on CXR, then insert a large bore chest drain (28-32F) using the traditional surgical technique in order to [6]:
Give prophylactic antibiotics as guided by your local antibiotic prescribing policy.
Enrol the support of thoracic surgical colleagues for >moderate haemothorax. ATLS [5] recommends thoracotomy for:
Do not forget that empyema rates following chest drain insertion for any traumatic indication is approximately 2.5% – give your patients prophylactic antibiotics (cephalosporins or clindamycin) [7].
Learning bite
A haemothorax visible on chest x-ray requires a large bore chest drain.