Initial treatment is directed to cardiopulmonary stabilization and evacuation of the pleural blood collection. If the patient is hypotensive, a large-bore intravenous line should be established. Appropriate fluid resuscitation should be commenced with blood transfusion as necessary. To evacuate, a large-bore thoracotomy tube should be placed and directed toward the costophrenic angle. If a conventional chest tube is not removing the blood collection, further steps may be necessary to prevent empyema and fibrothorax.
Conventional treatment involves placement of a second thoracostomy tube.
However, in many patients this therapy fails, necessitating further intervention. Video-assisted thoracoscopy has been proposed as an alternative treatment to permit direct removal of clot and precise placement of chest tubes. Emergency department care The patient should be sitting upright unless other injuries contraindicate this position. Administer oxygen and reassess airway, breathing, and circulation. An upright chest radiograph should be obtained as quickly as possible.