Massive Haemothorax

A massive haemothorax is by definition a haemothorax of 1500ml (30% circulating blood volume). Clearly it is not possible to determine the exact volume of a haemothorax at the pitch side, so it is useful for practical purposes to consider a massive haemothorax as a haemothorax which is causing breathing or circulation compromise. This condition causes compromise by interfering with gas exchange, as well as potentially causing hypovolaemia.

Recognition of a massive haemothorax

  • Tachypnoea
  • Tachycardia
  • Ipsilateral reduced air entry
  • Ipsilateral “stoney dull” percussion note
  • Possibly hypotension

Treatment of massive haemothorax

Management of this condition involves applying high flow oxygen via a non-rebreathe mask, fluid resuscitation if indicated by the loss of the radial pulse, with 250 ml boluses of crystalloid (in blunt injury) and rapid transfer to an Emergency Department.