evacuation of the pleural air should be performed with a 14 gauge needle
thoracostomy at the second intercostal space, mid-clavicular line.
Subsequently, definitive treatment requires a tube thoracostomy.
Hemothorax secondary to thoracic trauma typically only requires
evacuation with tube thoracostomy and surgery is rarely indicated. In order to
adequately drain hemothoraces and avoid tube obstruction from clots, large
chest tubes are preferred. Chest tubes should be placed in the dependent
position to permit adequate drainage in a supine patient. Inadequately drained
blood can lead to the development of fibrothorax and lung entrapment.
Initial output of blood at chest tube placement should be monitored
closely. Massive hemothorax is characterized as hemorrhage exceeding 20%
to 30% of the child’s blood volume at initial tube insertion, or persistent bloody
drainage at a rate more than 3 cc per kilogram per hour. In these cases of
severe hemorrhage, emergent thoracotomy should be considered to achieve
hemostasis.
C. Rib Fractures
Rib fractures are less common in the children when compared to adults,
secondary to the greater flexibility of the pediatric chest wall. It occurs in only
1% to 2% of pediatric trauma victims and most commonly is the result of blunt
trauma from motor vehicle accidents, pedestrian accidents, or child abuse.
Physical exam rarely identifies substantial clinical findings and diagnosis is
established most frequently by a screening chest radiograph performed at the