Signs of Life (pre or in-hospital)
Pulse, BP, pupil reactivity, purposeful movement, respiratory effort
Cardiac Activity
PEA is acceptable
Unresponsive hypotension
SBP<70 despite treatment
Pulse, BP, pupil reactivity, purposeful movement, respiratory effort
Cardiac Activity
PEA is acceptable
PEA is acceptable
SBP<70 despite treatment
Witnessed signs of life (pre or in-hospital)
Rapid exsanguination
>1000-1500mL initial drainage or >200mL/hr from Chest tube
Consider for exsanguinating abdominal vascular injuries with witnessed signs of life
Unresponsive hypotension
SBP<70 despite treatment
>1000-1500mL initial drainage or >200mL/hr from Chest tube
SBP<70 despite treatment
Thoracoabdominal trauma patients with persistent SBP < 70-80 despite aggressive resuscitation
Evidence of cardiac tamponade or progressively increasing hemothorax
Chest tube drainage
> 20ml/kg initially (> 1500ml in adult)
> 3 ml/kg/hr for 2-4hrs (> 200 mL/hr for 2-4hr in adult)
Persistent bleeding > 7 ml/kg/hr
Persistent air leak (bronchopleural fistula)
> 20ml/kg initially (> 1500ml in adult)
> 3 ml/kg/hr for 2-4hrs (> 200 mL/hr for 2-4hr in adult)
Persistent bleeding > 7 ml/kg/hr
Persistent air leak (bronchopleural fistula)
Thoracotomy
Needle thoracostomy
Finger thoracostomy
Thoracic lavage
Pulmonary antibiotics
Chest tube
Chest tube 
Thoracentesis