Hemothorax related to trauma

Management of hemothoraces related to trauma follows basic tenets well-respected by both trauma and cardiothoracic surgeons. In most, a nonoperative approach is adequate with a defined group of patients requiring only tube thoracostomy. It is only in a true minority of individuals that operative intervention is necessary. In blunt thoracic injuries, the underlying organ damage may be the more life-threatening process, not the presence or absence of a hemothorax. For both blunt and penetrating injuries, the presence of retained hemothorax is well-treated by early intervention with thoracoscopic techniques, shown to decrease hospital stay and costs. Controversial areas including the use of prophylactic antibiotics, sequence of operative intervention in patients with combined thoracoabdominal trauma, and the use of emergency department thoracotomy, remain a challenge but recent literature can serve to guide the clinician.