Still Not Bored Review

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Welcome to the procedure block’s first Bored Review

You are working in CCT at 3am when the patient arrives. Young man with multiple GSW’s to chest. You address his ABCs – he is not breathing and has no pulse. EMS swears he had VS before they took him out of the ambulance.

What procedure do you do?

ED Thoracotomy! (though ATLS may want you to intubate first)

 

When is this procedure indicated?

penetrating trauma to the chest with VS in the field or in the ED who deteriorate.

 

Please describe the first 3 steps of this procedure?

1. Cut skin through subq in Left 4th or 5th intercostal space with one cut. (though not listed, can pour iodine solution over chest first)

2. Use Mayo scissors to cut any remaining intercostal muscles.

3. Insert retractor with crank inf/lat and open chest

 

Once you are here, what is the next most important step?

Expose the heart and open the pericardium. Be sure to start the incision anterior (or towards the supine patient’s chest) to the phrenic nerve and cut from inferior to superior (from the apex to the aortic root).

 

Interested in more learning?

check out these links here, here, and here

 

By Dr. Andrew Grock and Dr. Sally Bogoch

 

References

Tintanalli’s

Peer VIII

http://lifeinthefastlane.com/ed-thoracotomy-is-it-just-the-first-part-of-the-autopsy/

http://www.trauma.org/archive/thoracic/EDToperative.html

http://emedicine.medscape.com/article/82584-overview#showall

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