Thoracotomy Flashcards
If circulation is restored during a resuscitative thoracotomy, what happens next?
Move patient directly to theatre
If defibrillation is required during a thoracotomy, how is it delivered and at what energy?
Internal paddles and initial energy of 10 joules
How to control bleeding during a thoracotomy?
Holes less than 1cm can normally be occluded using a finger
Large defects: Foley catheter can be passed through the hole and gently inflated
Closure with large sutures
What 3 scenarios will happen after a thoracotomy has been started?
Return of spontaneous circulation
The heart will begin to beat slowly and will appear empty. Any wounds should be rapidly closed and rapid transfusion to support circulating volume should be continued
The heart remains asystolic, wounds should be quickly closed and cardiac massage commenced
Can a resuscitative thoracotomy be performed on patients who have non-cardiac thoracic injuries?
Yes, especially suspected abdominal exsanguination
When are patients more likely to have a better outcome from a resuscitative
thoracotomy?
Patient that present to ED with a sustainable cardiac rhythm and obtainable vital signs
What is a sign of life?
Pupillary response
Spontaneous ventilation
The presence of carotid pulse
Measurable or palpable blood pressure
Extremity movement
Any cardiac electrical activity
What are the predictors of survival following a resuscitative thoracotomy?
Mechanism of injury
Anatomical injury location
Physiological derangement
Performance of pre-hospital CPR
Patients presenting with signs of life or presence of vital signs
What are successful outcomes for a resuscitative thoracotomy associated with?
Penetrating trauma and the presence of cardiac tamponade
What is the indication for a resuscitative thoracotomy?
Cardiac arrest following
trauma
What technique is used to provide complete exposure of the thoracic cavity?
Clamshell thoracotomy
