ED Thoracotomy Instructions



Getting Into the Chest:

1. Bilateral finger thoracotomies

  • 4th or 5th intercostal space

  • Scalpel - clamp - finger

2. Extend cut from sternum - bed

  • Curve along rib

  • Scalpel through skin and subcutaneous tissue

  • Scissors through intercostal muscles

3. Cut through sternum

  • Scissors or saw

4. Open chest with rib spreaders

  • Put U of spreaders towards U



Inside the Chest:

5. Deliver Heart

  • Right mainstream intubation

  • Cut midline longitudinal incision

  • Evacuate clots/blood

  • Apply pressure to wounds

  • Stop if: Asystole and no tamponade

6. Apply clamp/pressure to bleeding

  • Ex: visible bleeding vessels, lung tissue

7. Compress aorta

  • Insert OG tube to identify esophagus

  • Run hand along ribs until feel aorta

  • Compress with fingers against spine

8. Cardiac Massage

  • 2 flat hands

  • Clapping motion apex - base

  • Heart held horizontal



Dr. Sarah Foohey @SarahFoohey



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