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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, April 19, 2019

Clamshell Thoracotomy

R.E.B.E.L.EM - April 18, 2019 - By Zaf Qasim
"Every now and again someone raises the issue on social media about resuscitative thoracotomy. What are the indications (we have the EAST guidelines for that), what are the risks (highlighted in this important recent paper), and of course, whether EM or surgery should be doing it in the trauma bay (guess what – it’s in the curriculum for both specialties).
That’s not the point of this post. This post is about how I think you, as the emergency medicine physician (EP), working in a system where your surgeon is not in-house, but is available in a reasonable amount of time, should proceed when faced with the patient who meets the indications. You’ve gone through your HOTTT(T) algorithm and are now at that final “T” – you have to open the chest...
Final Thoughts
The end-point, ideally, is ROSC, when a few things may happen. The patient may wake up and so will require appropriate sedation. The internal mammary arteries may start bleeding and should be controlled with hemostats or tied off. Remember – you need to have a plan to get the patient expediently to surgical care and resuscitation should remain ongoing.
Even if you do not achieve ROSC, at least you will know that when the decision was made to proceed with thoracotomy, you did the best you could for the patient."