Treatment
- Intravenous fluid resuscitation keeping in mind that blood loss should preferably be replaced with blood. Always insert two wide bore IV cannulae in these patients.
- Appropriate use of blood and blood products. Think about activating the Major Haemorrhage Protocol (MHP).
- Insert a chest drain, connecting the drain to a cell salvage/saver machine for autotransfusion purposes (image right – Fig 10: Cell salvage/saver machine). If a cell saver is not readily available then prepare the usual drainage apparatus, but prime the underwater seal with saline not sterile water. The saline/blood collection can still be run through a cell saver later.
- Occasionally a massive haemothorax may be well tolerated, typically in young patients with a chest stabbing. Delaying chest drain insertion until reaching thoracic theatre, where cell salvage exists, is an option.
- Whilst a guideline for thoracotomy exists (see table below), have a low threshold for engaging thoracic surgeons early.
| ATLS indications for thoracotomy [2] |
|