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Traumatic haemothorax — SCE Respiratory MCQ

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HardPleural DiseaseTraumatic haemothoraxSCE Respiratory

A 35-year-old man has pleuritic pain after a road traffic collision. CXR shows a large left pleural opacity; pleural fluid haematocrit is 32% and blood haematocrit is 39%. He is tachycardic and hypotensive. What is the most appropriate management?

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Correct answer: D — Urgent chest drain insertion and surgical referral

The best answer is “Urgent chest drain insertion and surgical referral”. Urgent chest drain insertion and surgical referral is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Outpatient follow-up CXR in 6 weeks, within a respiratory pathway”, “Chemical pleurodesis via small catheter, after safety review”, “Trial of oral antibiotics, after specialist assessment”, “Therapeutic anticoagulation, with clinical reassessment, with clinical reassessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1