Management

1. If small, observe with serial X-rays and monitor for signs of cardiorespiratory deterioration.

2. Ensure any coagulopathy is corrected by administration of fresh frozen plasma and/or platelets as indicated.

3. Ensure that cross-matched blood is available for urgent transfusion if necessary.

4. If significant in size or patient becomes symptomatic, insert large bore chest drain, e.g. size 28 Fr. The drain should be directed postero-inferiorly toward the dependent area of lung and placed on 5kPa suction.

5. If drainage exceeds 1000ml or >200ml/h for 3-4h despite correcting any coagulopathy, contact thoracic surgeon.

6. Factor Vila may be considered for intractable bleeding, though only anecdotal reports of benefit exist.

7. Drains inserted for a haemothorax may be removed after 1-2 days if no further bleeding occurs.

Perforation of an intercostal vessel during chest drain insertion may cause considerable bleeding into the pleura. If deep tension sutures around the chest drain fail to stem blood loss, remove the chest drain and insert a Foley urethral catheter through the hole. Inflate the balloon and apply traction on the catheter to tamponade the bleeding vessel. If these measures fail, contact a thoracic surgeon.

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