Emergency Department Thoracotomy

1) OBJECTIVES

a) Release cardiac tamponade

b) Internal cardiac massage

c) Control hemorrhage

d) Repair cardiac wounds

e) Compress descending aorta

2) INDICATIONS

a) Patients who sustain a cardiac arrest or are moribund from an isolated penetrating thoracic injury

b) Patients who sustain a cardiac arrest or are moribund from blunt trauma. These patients generally do not have a good prognosis

c) Select medical cardiac arrested patients, such as the young, otherwise healthy individual

3) TECHNIQUE

a) Left antero-lateral approach

b) Prepare and drape the left chest

c) Curvilinear incision between 4^th and 5^th interspace from mid-sternum to mid-axillary line

d) Avoid breast tissue in females, and internal mammary and intercostals vessels

e) Incise through subcutaneous tissue, pectoralis major and serratus anterior muscle

f) Use a clamp to puncture through the intercostals muscles above the 4^th and 5^th rib during expiration, and spread along the rib

g) Use a large Mayo scissor to incise the intercostals muscles along the superior aspect of the rib

h) Insert a self retaining rib spreader and dilate as much as possible for maximal exposure

i) Proceed to perform procedures as indicated, including internal massage, release of pericardial tamponade, hilum hemorrhage control, repair of cardiac wound, etc.

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