Thoracotomy - Revision history

Blsimpso: /* External Links */

2021-07-16T13:58:48Z

External Links

← Revisión anterior		Revisión del 13:58 16 jul 2021
Línea 94:		Línea 94:
	*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]		*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]
	*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/ CriticalCareNow: A Cracking Way to Start the New Year]		*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/ CriticalCareNow: A Cracking Way to Start the New Year]
	*[https://emedicine.medscape.com/article/82584-overview#showall Medscape - Emergency Bedside Thoracotomy]

	==References==		==References==

Blsimpso: /* External Links */

2021-07-02T14:24:03Z

External Links

← Revisión anterior		Revisión del 14:24 2 jul 2021
Línea 94:		Línea 94:
	*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]		*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]
	*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/ CriticalCareNow: A Cracking Way to Start the New Year]		*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/ CriticalCareNow: A Cracking Way to Start the New Year]
			*[https://emedicine.medscape.com/article/82584-overview#showall Medscape - Emergency Bedside Thoracotomy]

	==References==		==References==

Rossdonaldson1: /* Procedure */

2021-04-08T19:56:02Z

Procedure

← Revisión anterior		Revisión del 19:56 8 abr 2021
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	==Procedure==		==Procedure==
			[[File:Gray530.png\|thumb\|Left pleura cavity (viewed from left) showing intercostal bundles (vein, artery, and nerve) under ribs.]]
	[[File:1459269 1749-7922-1-4-4.png\|thumb\|ED thoracotomy]]		[[File:1459269 1749-7922-1-4-4.png\|thumb\|ED thoracotomy]]
	#[[Intubate]] and place NGT		#[[Intubate]] and place NGT

Elcatracho: /* External Links */

2021-02-18T05:42:53Z

External Links

← Revisión anterior		Revisión del 05:42 18 feb 2021
Línea 92:		Línea 92:
	*[https://emcrit.org/emcrit/procedure-of-thoracotomy/ EMCrit: Crack to Cure]		*[https://emcrit.org/emcrit/procedure-of-thoracotomy/ EMCrit: Crack to Cure]
	*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]		*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]
	*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/]		*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/ CriticalCareNow: A Cracking Way to Start the New Year]

	==References==		==References==

Elcatracho: /* External Links */

2021-02-18T05:42:01Z

External Links

← Revisión anterior		Revisión del 05:42 18 feb 2021
Línea 92:		Línea 92:
	*[https://emcrit.org/emcrit/procedure-of-thoracotomy/ EMCrit: Crack to Cure]		*[https://emcrit.org/emcrit/procedure-of-thoracotomy/ EMCrit: Crack to Cure]
	*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]		*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]
			*[https://criticalcarenow.com/2021/01/05/a-cracking-way-to-start-the-year/]

	==References==		==References==

Elcatracho: /* External Links */

2021-02-04T04:11:44Z

External Links

← Revisión anterior		Revisión del 04:11 4 feb 2021
Línea 90:		Línea 90:

	==External Links==		==External Links==
			*[https://emcrit.org/emcrit/procedure-of-thoracotomy/ EMCrit: Crack to Cure]
			*[https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/ REBEL EM: The Clamshell Thoracotomy]

	==References==		==References==

Elcatracho: /* Complications */

2021-02-04T04:09:52Z

Complications

← Revisión anterior		Revisión del 04:09 4 feb 2021
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	==Complications==		==Complications==
			*Risk of percutaneous injury and exposure to blood-borne pathogens to operator

	==Comments==		==Comments==

ClaireLewis at 15:44, 10 October 2019

2019-10-10T15:44:46Z

← Revisión anterior		Revisión del 15:44 10 oct 2019
Línea 1:		Línea 1:
	==Indications==		==Indications==
	===ED Thoracotomy===		===ED Thoracotomy===
	====Penetrating chest trauma====		====Penetrating [[chest trauma]]====
	*Signs of Life (pre or in-hospital)		*Signs of Life (pre or in-hospital)
	**Pulse, BP, pupil reactivity, purposeful movement, respiratory effort		**Pulse, BP, pupil reactivity, purposeful movement, respiratory effort
	**Cardiac Activity		**Cardiac Activity
	***PEA is acceptable		***PEA is acceptable
	*Unresponsive hypotension		*Unresponsive [[hypotension]]
	**SBP<70 despite treatment		**SBP<70 despite treatment

	====Blunt chest trauma====		====Blunt chest trauma====
	*Witnessed signs of life (pre or in-hospital)		*Witnessed signs of life (pre or in-hospital)
	*Rapid ~~ensanguination~~		*Rapid exsanguination
	**>1000-1500mL initial drainage or >200mL/hr from Chest tube		**>1000-1500mL initial drainage or >200mL/hr from Chest tube
	*Consider for exsanguinating abdominal vascular injuries with witnessed signs of life		*Consider for exsanguinating abdominal vascular injuries with witnessed signs of life
	*Unresponsive hypotension		*Unresponsive hypotension
	**SBP<70 despite ~~treatmetn~~		**SBP<70 despite treatment

	===OR Thoracotomy===		===OR Thoracotomy===
Línea 27:		Línea 27:

	==Goals==		==Goals==
	*Release tamponade		*Release [[tamponade]]
	*Control intrathoracic/cardiac bleeding		*Control intrathoracic/cardiac bleeding
	*Control air embolism		*Control air embolism
Línea 72:		Línea 72:
	#*Indicated after persistent hypotension after pericardiotomy and fluid resus		#*Indicated after persistent hypotension after pericardiotomy and fluid resus
	#*Aorta posterior to NGT		#*Aorta posterior to NGT
	#[[Autotransfuse]] thoracic blood		#[[pRBCs\|Autotransfuse]] thoracic blood
	#If no evidence of injury to L-side, but possible R-sided injury, extend to R side (clam shelling)		#If no evidence of injury to L-side, but possible R-sided injury, extend to R side (clam shelling)

Línea 95:		Línea 95:
	[[Category:Procedures]]		[[Category:Procedures]]
	[[Category:Trauma]]		[[Category:Trauma]]
			[[Category:Critical Care]]

Bmurray990: /* Procedure */

2019-01-24T15:42:44Z

Procedure

← Revisión anterior		Revisión del 15:42 24 ene 2019
Línea 36:		Línea 36:

	==Equipment Needed==		==Equipment Needed==
			*PPE
			*Thoracotomy Tray
			**Rib Spreader
			** #10 or #21 Scalpel, Scissors, Forceps
			**Vascular Clamps, Curved Artery Forceps, Needle Driver
			**Internal Defibrillation Paddles
			**Skin Stapler, Suture Material

	==Procedure==		==Procedure==
Línea 60:		Línea 67:
	#Internal Defibrillation		#Internal Defibrillation
	#*Lower voltages than external defibrillation		#*Lower voltages than external defibrillation
			#*Start at 5J to a max of 50J
	#Cross Clamp Aorta		#Cross Clamp Aorta
	#*Up to 30 min is tolerated		#*Up to 30 min is tolerated
Línea 75:		Línea 83:
	*Meta-analysis reports overall rates closer to 1.5% with favorable neurologic outcome<ref name="slessor">Slessor D, Hunter S. To be blunt: are we wasting our time? Emergency department thoracotomy following blunt trauma: a systematic review and meta-analysis. Ann Emerg Med. 2015 Mar;65(3):297-307</ref>		*Meta-analysis reports overall rates closer to 1.5% with favorable neurologic outcome<ref name="slessor">Slessor D, Hunter S. To be blunt: are we wasting our time? Emergency department thoracotomy following blunt trauma: a systematic review and meta-analysis. Ann Emerg Med. 2015 Mar;65(3):297-307</ref>
	*Best outcomes occur if the patient arrested less than 15 minutes before the procedure.		*Best outcomes occur if the patient arrested less than 15 minutes before the procedure.
	*For ~~penetrating chest~~ trauma ~~with cardiac tamponade the~~ survival rate may be closer to 0.07%<ref name="slessor" />		*For blunt trauma survival rate may be closer to 0.8%<ref name="slessor" />

	==See Also==		==See Also==

Ravillaa: /* ED Thoracotomy */

2017-08-02T14:33:31Z

ED Thoracotomy

← Revisión anterior		Revisión del 14:33 2 ago 2017
Línea 1:		Línea 1:
	==Indications==		==Indications==
	===ED Thoracotomy===		===ED Thoracotomy===
	*Penetrating chest trauma ~~with signs~~ of ~~life~~ in ~~the field~~		====Penetrating chest trauma====
	**Pulse, BP, pupil reactivity, purposeful movement~~, organized rhythm~~, respiratory effort)		*Signs of Life (pre or in-hospital)
	*Blunt chest trauma ~~with~~ signs of life ~~lost~~ in ED		**Pulse, BP, pupil reactivity, purposeful movement, respiratory effort
	*Consider for exsanguinating abdominal vascular injuries		**Cardiac Activity
			***PEA is acceptable
			*Unresponsive hypotension
			**SBP<70 despite treatment

			====Blunt chest trauma====
			*Witnessed signs of life (pre or in-hospital)
			*Rapid ensanguination
			**>1000-1500mL initial drainage or >200mL/hr from Chest tube
			*Consider for exsanguinating abdominal vascular injuries with witnessed signs of life
			*Unresponsive hypotension
			**SBP<70 despite treatmetn

	===OR Thoracotomy===		===OR Thoracotomy===