1. Minimal (500 ml or less)

   • Observe
     • No progression
       • Repeat film
       • Clearing
       • No treatment
     • Increasing hemothorax
       • Chest tube
         • Bleeding stops. Clearing and no further treatment
         • Continued bleeding exceeding 1000 mL requires thoracotomy

2. Moderate (300 - 800 mL)

   • Chest tube
     • Bleeding stops
       • Clearing and no further treatment
       • Persistent hemothorax requires thoracotomy
     • Continued bleeding requires thoracotomy

3. Major (more than 1000 mL)

   • Opacified hemothorax
   • Over 1000 mL immediate loss
   • Unstable patient not responding to volume
   • Continued loss
     • > 100 mL/hr after 6 - 8 hours - thoracotomy
     • or loss > 200 mL/hr after 2 - 4 hours] - thoracotomy

4. Findings that require arteriography regardless of state or volume of hemothorax.

   • Widened mediastinum
   • First rib fracture with pulse deficit, neurological deficit, or expanding hematoma.

From Hood RM: Surgical Diseases of the Pleua and Chest Wall. Philadelphia. WB Saunders Co. 1986, p 222.