ECMO-/ECLS

Hemothoraces develop from bleeding into the pleural space, which may
originate from intercostal vessels, lung parenchymal injury, or pulmonary
vasculature.
On physical exam, diminished breath sounds may be noted on the
affected side during auscultation or subcutaneous emphysema may be felt on
palpation of the chest wall. With percussion of the chest, hyperresonance is
suggestive of a pneumothorax, while dullness is associated with a hemothorax.
A pneumothorax is seen on screening chest radiograph as a collapsed lung
with a visceral pleural line outlined by free pleural air. If an associated
hemothorax is present, it presents as a pleural effusion. Thoracic CT is highly
sensitive for pneumothorax and illustrates air in the pleural space.
Pneumothorax not apparent on plain chest x-ray, but diagnosed incidentally by
CT scan is termed an occult pneumothorax.
Management for a traumatic pneumothorax in a stable patient requires
the placement of a tube in the pleural space, in order to remove trapped air and
allow lung reexpansion. Early intervention is necessary because the pediatric
mediastinum is at increased risk of tension physiology, due to its increased
mobility. Chest tube size should be determined by patient size and if there is
an associated hemothorax present (Table). Small chest tubes are sufficient for
isolated pneumothoraces, while larger tubes should be used to evacuate both
air and blood in the case of a hemopneumothorax.
To place a chest tube, the affected chest is prepped and draped in
sterile fashion allowing exposure of the nipple, which serves as a landmark for