ED Thoracotomy: When NOT? Post-injury Cardiac arrest –Penetrating: > 15mins CPR and NO SOL –Blunt: > 5 mins CPR and NO SOL Prior chest surgery (sternotomy, thoracotomy)
ED Thoracotomy: Survival correlates with Injury pattern and status of patient Injury Pattern ShockNo V/SNo S.O.L Overall Cardiac35%19%3%16% Penetr.14%8%1%10% Blunt2%1%01.4%
ED Thoracotomy: Technical aspects Supine, Left arm out of the way Incision: left submammary; clamshell Pericardiotomy
ED Thoracotomy: Technical aspects Pericardiotomy: –Hemorrhage control –Cardiac repair –Foley technique
ED Thoracotomy: Technical aspects Open massage and resuscitation: –2-hand technique –Intracardiac epinephrine –Internal defibrillation
ED Thoracotomy: Technical aspects Occlude thoracic aorta: –Retract lung superiorly, suction –Dissect out aorta just above diaphragm
ED Thoracotomy: Purpose Release tamponade Control exsanguinating intrathoracic hemorrhage Open cardiac massage –Closed chest CPR: 25% CO, 20% cerebral perfusion – OK for 15 mins at normothermia Clamp aorta Deal with broncho-venous air embolism
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