What is the recommended treatment for a large-volume hemothorax?

• A. Drain the empyema
• B. Remove blood
• C. Administer antibiotics
• D. Pleurodesis

Answer: (B)

When a large-volume hemothorax occurs, the immediate goal is to evacuate the blood from the pleural space to re-expand the lung and prevent ongoing blood loss from compressing lung tissue. The standard immediate step is draining the pleural space with a chest tube (tube thoracostomy). This directly treats the problem by removing blood, allowing the lung to re-expand, improving oxygenation, and reducing the risk of fibrothorax.

Antibiotics are not routinely used unless there is a concern for infection, which isn’t the primary issue in acute bleeding. Pleurodesis is a procedure to prevent recurrent pleural fluid or pneumothorax and is not an acute management step for a hemothorax. Simply removing blood without drainage isn’t feasible in this context because the blood must be evacuated from the pleural space to restore lung function. If bleeding continues despite drainage, surgical exploration may be needed, but the first-line treatment for a large-volume hemothorax is draining the blood.