HWN Suggests

GSW to the Chest

If you don’t have a rib spreader, go with the manual technique. You only need three things: chlorhexidine, a scalpel and a pair of hands! Simply douse the patient in chlorhexidine, cut from the sternum to as far down the lateral side as possible – giving the patient a huge chest “gill”.

You then just grab the ribs with your hands and pull the chest open. If you don’t get enough exposure you haven’t given the patient a big enough gill. This method is lightning fast and frees your rather tense mind from worrying about how to orient the rib splitter and other stuff in the thoracotomy tray.

read full article

Featured

 C: Pre Hospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest – data from 21 years at London’s Air Ambulance

Suspect tamponade with penetrating trauma to the thorax or epigastrium. Intervene as early as possible, within 15 minutes of arrest, and don’t delay to adapt the situation Suspect exsanguination with penetrating trauma elsewhere, or with blunt trauma. Rule out tamponade where possible – this may require ultrasound or even ‘diagnostic’ RT. Intervention needs to be immediate, else it is futile. Learn to recognise futility and do not feel compelled to intervene. Injuries (physical & psychological) are risks to ourselves, colleagues, and ‘bystanders’ from this procedure.

 If You’re Going to do the Thoracotomy…do a Clamshell

When you are doing this for the first or second time in your career, you need to be able to see what you need to see, and the clamshell affords you much better exposure of the things you can possibly intervene on than a left anterolateral approach.

Articles of Interest

Emergency thoracotomy: “how to do it”

It is important to have a realistic expectation of what can be achieved by emergency thoracotomy. The procedure tackles a single pathology—cardiac tamponade with a controllable wound in the heart. If the underlying injury is any more complex than this a good outcome is unlikely outside a specialist surgical centre with a fully equipped cardiothoracic theatre and cardiopulmonary bypass facilities.

The Abbreviated ED Thoracotomy Tray

What instruments do you actually need for ED Thoracotomy...