Traumatic Cardiac Arrest: ED Thoracotomy Instructions

1. CALL FOR HELP.

2. GATHER SUPPLIES.

   +/- Sterile gloves, towel, chlorhexidine

   Thoracotomy Tray

   For opening: Scalpel + Scissors, Finochietto retractor (spreaders)

   For sternum: Sternal saw, Lebsche knife & mallet, or shears

   For inside: Clamps, Forceps, Needle driver, Sutures

3. GET INTO CHEST.

   If-time, make strile: Gloves, chlorhexidine, towels.

   Make cut: Scalpel, 4cm at 4th ICS, along rib, skin + subcut

   Extend cut: Scissors, up to sternum, down towards axilla. Use 2 fingers to protect the lung, cutting over hand.

   Open up: Retractor. Hand crank & long bar are lateral. Repeat on other side.

   Cut sternum: Sternal saw, trauma scissors.

4. INSIDE THE CHEST:

   Correct reversible pathology: bleeding, obstruction.

   Highest survival rate after isolated cardiac injury.

Evacuate Pericardium

Repair Laceration on heart

Cardiac Massage

Cross-Clamp Aorta

Intrathoracic Hemorrhage

Air Embolism



Dr. Sarah Foohey @SarahFoohey



#Thoracotomy #Instructions #procedure #emergency #trauma #checklist #thoracic