Still Not Bored Review

by andygrock • October 28, 2014 • Comments Off

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

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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andygrock

Resident Editor In Chief of blog.clinicalmonster.com.
Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
Resident at Kings County Hospital