Treatment of a hemothorax focuses on stabilizing the patient's condition by maintaining airway and breathing, stopping the bleeding, emptying blood from the pleural cavity, and re-expanding the underlying lung. Mild cases of hemothorax may resolve in 10 days to 2 weeks, requiring only observation for further bleeding. More severe cases of hemothorax (hemorrhaging that arises from arterial sites or major hilar vessels) generally require aggressive surgical intervention. Autotransfusion, a system that allows blood removed from the pleural cavity to be returned to the patient intravenously, is useful in the initial management of the patient with hemothorax. Reinfusion of shed blood from the chest injury can be accomplished by a variety of techniques. Significant blood loss may lead to hypovolemic shock.

A tube thoracostomy is the treatment of choice for hemothorax; approximately 80% of penetrating and blunt trauma can be managed successfully with this procedure. A hemothorax with a volume of 500 to 1500 mL that does not continue to bleed can be managed with a chest tube alone. A massive hemothorax, with an initial volume of 1500 to 2000 mL or one that continues to bleed between 100 and 200 mL per hour after 6 hours is an indication for a formal thoraco-tomy. Placement of more than one chest tube may be necessary to drain a hemothorax adequately.

An emergency thoracotomy at the bedside may be necessary in the setting of a massive hemothorax with accompanying hemodynamic instability. The approach is a left anterolateral incision and is reserved for those patients who are in a life-threatening situation. A formal thoracotomy performed in the operating room is accomplished by a variety of incisions. Once exposure is obtained, lung parenchyma and vascular structures, including the great vessels, can be evaluated and repaired.

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