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Hello again from the Emergency Procedures team,

Today we are re-visiting the big one, Resuscitative Thoracotomy.

Possibly the most terrifying emergency procedure, but also one which carries a high chance of saving a life.

This is one to prepare for inside out.

Detailed written instructions and explanation are available in our Free App (iOS and Android). This video is hot off the press and we want your help improving it. Drop us a line with any suggestions

So, without further ado…here is the video


Q&A

When should I perform an Emergency Department Thoracotomy?

PRIMARY INDICATION

  • Traumatic cardiac arrest
  • Loss of output for <10 minutes

AND

  • Penetrating chest or epigastric injury

AND

  • Cardiothoracic surgery accessible post procedure
  • Either specialist, trauma surgeon or via retrieval

SECONDARY INDICATION

  • Traumatic cardiac arrest
  • Loss of output for <10 minutes

AND

  • Blunt Trauma With US confirmed pericardial fluid

AND

  • Cardiothoracic surgery accessible post procedure
  • Either specialist, trauma surgeon or via retrieval

What is an emergency thoracotomy a treatment for?

Resuscitative thoracotomy is primarily indicated in penetrating traumatic cardiac arrest and is a treatment for penetrating right ventricular injury resulting in pericardial bleeding and death caused by cardiac tamponade.

In this circumstance no other tests are required, and the procedure should be immediately and quickly performed

Should a thoracotomy ever be performed for cardiac arrest after blunt trauma?

Rarely, but not never. In a small patient group, it can be lifesaving.

Cardiac tamponade is much less common in blunt trauma but it does occur, for example a rib fracture can penetrate the pericardium and heart, or a thin walled chamber, often the right ventricle, can rupture at the time of impact.

We recommend thoracotomy in blunt trauma only if a pericardial effusion is seen on ultrasound. If pericardial effusion is not present, performing a thoracotomy is likely to cause harm and detract from interventions more likely to save a life such as massive transfusion, and control of haemorrhage

Will I really be able to fix anything inside the chest?

You don’t need to fix anything.

Your role is to save the patient’s life by relieving cardiac tamponade, then place a finger over a cardiac laceration and resuscitate until help arrive

I’ve spotted an improvement that could be made to your video and guide?

Don’t be shy, let us know! Drop us a line


The App


Emergency Procedures

Associate Professor Christopher Groombridge MBBS MA(Cantab) MSc DOHNS (RCSEng) DRTM (RCSEd) DIMC (RCSEd) MRCS PhD FACEM. Emergency and Trauma Physician, Alfred Hospital, Melbourne, National Trauma Research Institute

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist  Emergency Medicine, Prince of Wales Hospital. Lead author of Lead author of Emergency Procedures App | Twitter | YouTube |

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