Understanding Massive Haemothorax in Chest Injury

A massive haemothorax, defined as the accumulation of a large volume of blood in the pleural space, requires prompt and aggressive management. Draining 1800 ml of blood via tube thoracostomy indicates a significant and ongoing haemorrhage, likely from injury to intercostal vessels or the internal mammary artery.

Evaluating Treatment Options

The primary goals are to control haemorrhage, restore haemodynamic stability, and ensure adequate oxygenation.

• Option 1: Correction of hypovolemic shock - While essential for any patient losing significant blood volume, simply correcting shock without addressing the source of bleeding is insufficient.
• Option 2: Put one more chest tube - A second chest tube will not stop the source of the bleeding and is not the definitive treatment for massive haemorrhage.
• Option 3: Clamp the chest tube to cause tamponade - Clamping the tube is dangerous in haemothorax. It prevents further drainage, hinders lung re-expansion, and can worsen shock. Cardiac tamponade is a different condition.
• Option 4: Resuscitation and prepare for urgent thoracotomy - This is the most appropriate approach. Resuscitation addresses the haemodynamic instability (blood loss), while preparing for an urgent thoracotomy allows direct surgical control of the bleeding source, which is necessary given the massive volume drained.

Conclusion

For a massive haemothorax with continued bleeding after initial tube thoracostomy, prompt resuscitation combined with surgical intervention via thoracotomy is the standard of care to control the haemorrhage and stabilize the patient.