Indications for cardiothoracic surgical referral

Continuing massive air leak after chest drain insertion
Continuing haemorrhage after chest drain insertion
Cardiac tamponade
Disruption of the great vessels

Children who require ventilation as part of the treatment of their chest injury (such as those with significant pulmonary contusion) will need transfer to a paediatric intensive care unit. Critical care management will be needed for transfer and as part of continuing stabilisation in general. Appropriate medical and nursing referrals should be made.