In the management of traumatic haemothorax, an indication for immediate thoracotomy (rather than tube thoracostomy alone) is drainage of more than how much blood initially from a chest drain?
- A 500 mL of blood on initial drainage
- B 2000 mL of blood on initial drainage
- C 1500 mL of blood on initial drainage ✓
- D Any blood in the pleural cavity on chest X-ray
Correct answer: C. 1500 mL of blood on initial drainage
Explanation
According to ATLS guidelines, a massive haemothorax draining >1500 mL of blood immediately upon chest drain insertion, or ongoing blood loss >200 mL/hour over 2–4 hours, or haemodynamic instability despite drainage, are indications for thoracotomy (or video-assisted thoracic surgery) to control the source of bleeding. Initial drainage below this threshold may be managed conservatively with tube thoracostomy alone. The threshold ensures that both the volume and rate of haemorrhage, and not just any pleural blood, trigger operative intervention.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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