NOTE: this video is NOT standard technique.
Aka "cracking the chest". A potentially life saving technique , but overall survival rates anywhere from <2% to ~10% depending on clinical presentation.
There is a stanard thoracotomy surgical set that ER physician and trauma surgeons use typically at the bedside. Using a scalpel and hands is not typically taught if ever. This is an austere situation outside the United States.
1. Decompressing the chest and gaining access to the pleural cavity w/ relief of pressure&air is the lifesaving attempt. Not placement of the tube. You can decompress the chest and continue with your initial surveys and not place a tube right then.
2. Intial blood output >1200 to >1500cc (depending on source) or >200cc/hr warrants surgical exploration.
-control intrathoracic bleeding
-release cardiac tamponade
-cardiac injury repair
-internal cardiac massage -descending aorta crossclamp.
1. Patient should be intubated. Please know I believe there are times in trauma intial DCR that ETT placement is not priority and bvm/sga is sufficient. Not w/ this
2. Placement of NGT can help tactile feel for cross-clamp aorta
3. Review procedure frequently if in scope or assistant.
4. Before decision made for ERT, a surgeon and OR should be available for definitive care.
Multiple scholary articles and guidelines on these decisions. Some shops are more aggressive than others in decision pathway.
In the setting of civilian trauma, ERT is generally indicated only for penetrating trauma with either witnessed cardiac arrest or recent loss of vital signs (10-15min pre-arrival). ERT for blunt trauma is controversial (I've had both sides for blunt trauma)
Eastern Association for the Surgery of Trauma (EAST)
1. Penetrating thoracic trauma with signs of life but pulseless on arrival (only strong recommendation). This post is not all encompassing. Please read more or ask your local resucitationist
#Resuscitative #Thoracotomy #clinical #video #trauma