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Emergency Department Thoracotomy

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The content you’re about to read or listen to is at least two years old, which means evidence and guidelines may have changed since it was originally published. This content item won’t be edited but there will be a newer version published if warranted. Check the new publications and curriculum map for updates

Authors: Reuben Griscti / Codes: CMP3, C3AP1A, HMP3 / Published: 30/03/2015

Trauma is a significant cause of mortality worldwide, especially amongst children and young adults, with the majority of deaths occurring shortly after arrival in hospital. Thoracic trauma causes a quarter of all traumatic deaths, whilst contributing to a further 50%.

Emergency Department Thoracotomy will allow decompression of tension pneumothoraces, release of pericardial tamponade, closure of cardiac wounds, intrathoracic haemorrhage control, as well as effective open cardiac massage, making all the difference between life and death. Very few other procedures in Emergency Medicine have such a high mortality:benefit ratio. The Royal College of Emergency Medicine has stated that this procedure is definitely within the remit of the Emergency Physician. In this podcast, we will discuss the indications and contra-indications, as well as a simplified technique to perform a clamshell thoracotomy.

The only challenge that remains is making the call.

References:

  1. Tom Leckie, Ian Roberts, Fiona Lecky. Timing of trauma deaths within UK hospitals. [ONLINE] Available at: https://www.tarn.ac.uk/content/downloads/68/leckie1.pdf.
  2. Gretchen S Lent, Neel Kumar. 2013. Emergency Bedside Thoracotomy . [ONLINE] Available at: http://emedicine.medscape.com/article/82584-overview.

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