Chest Trauma

Immediate Life Threats

Delayed Life Threats

Penetrating Chest Trauma

Blunt Chest Trauma

Chest Tube Size
Condition Tube Size
Tension Pneumothorax
24-28 Fr
OR Needle thoracostomy
Open Pneumothorax 28 Fr
Hemothorax 32 Fr
Flail Chest 36 Fr (at least)
Malignant Effusion 8-18 Fr
Parapneumonic effusion Most Pt: 10-14 Fr (small cath for pt comfort)
Viscous fluid or loculated on CT: 16-24 Fr
Empyema Stage 1 Empyema: 28 Fr or larger
Stage 2 Empyema: chest tube warranted but may fail --> Thoracic surgery consult
Stage 3 Empyema: Chest tube drainage will almost assuredly result in treatment failure.

DDx of Life Threatening Chest Injuries (HOT and FAT CHEST):
Open pneumothorax
Tension pneumothorax
Flail chest
Airway obstruction
Contusion: pulmonary, myocardial
Hernia: traumatic, diaphragmatic
ESophageal perforation
Tracheobronchial disruption/
Traumatic injury