Resuscitative thoracotomy

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Resuscitative thoracotomy

Photographs show step-by-step guide of clamshell thoracotomy with markings for start by making bilateral finger thoracostomies, how to use Gigli saw to divide sternum, et cetera. Diagram shows e-Fast scan and its scanned areas with markings for anterior right lung, anterior left lung, pericardial view, perisplenic view, perihepatic view and pelvic view (bladder).

Pre-hospital resuscitative thoracotomy was once seen by some as an ‘heroic’ intervention with a very poor outcome. However, emerging evidence has identified a specific subgroup of patients whose survival rates, with good neurological outcomes, approach 60%, if the thoracotomy is performed promptly and by the right team.


Indications


Based on the above, patients must meet each of the following strict consensus criteria for progression to pre-hospital resuscitative thoracotomy (RT):



  • penetrating thoracic/epigastric injury
  • in witnessed cardiac arrest (i.e. signs of life immediately following injury and preceding loss of output)
  • attended within 10 minutes of loss of output
  • tension pneumothorax excluded as cause.

Currently, any other indication for pre-hospital RT is insufficiently supported by evidence and therefore difficult to justify; however, there is increasing support for RT in proximal haemorrhage control following penetrating abdominal injury.


Contraindications


Absolute contraindications are based on futility of RT:



  • medical cardiac arrest
  • downtime more than 10 minutes.

Blunt trauma, severe head injury and damage to more than one body region are associated with very poor outcomes and also currently preclude RT. It should also be noted, however, that in practice, it is often difficult to establish precise time of loss of output and as such RT is often carried out when downtime is unclear.

Mar 13, 2018 | Posted by in Uncategorized | Comments Off on Resuscitative thoracotomy

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