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Traumatic Haemothorax — RACP Adult Medicine MCQ

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EasyRespiratoryTraumatic HaemothoraxRACP Adult Medicine

A 35-year-old man involved in a high-speed motor vehicle accident presents with chest wall tenderness, reduced breath sounds on the left, and CXR showing a large left haemothorax (opacification of left hemithorax). He has left-sided rib fractures (ribs 5-8). BP is 95/60 mmHg, HR 125 bpm. What is the most appropriate management?

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Correct answer: A — Intercostal chest drain (large-bore, 24-32 Fr)

Traumatic haemothorax requires a large-bore intercostal drain (24-32 Fr) to evacuate blood, monitor ongoing blood loss, and prevent clotted haemothorax/empyema. Small-bore drains are inadequate for blood (viscous, clots easily). Urgent thoracotomy is indicated if initial drainage >1500 mL, or >200 mL/hr for 2-4 consecutive hours, suggesting major vascular injury.

Reference: ATLS 10th Ed 2018; eTG Emergency 2024