Obtain chest x-ray after chest tube has been placed. Massive bleeding into the pleural space results in hemorrhagic shock. After blunt trauma, source is usually bleeding from the chest wall. After penetrating injury, source is usually the result of direct injury to a vessel. Hemorrhagic shock and hemothorax on chest x-ray.
Absent breath sounds on affected side.
Dullness to percussion on affected side. Fluid resuscitate to correct hemorrhagic shock. Place large-bore chest tube. Consider CardioThoracic Surgery Consultation. Consider using blood salvage pleuravac for possible reinfusion.