ER Thoracotomy - SNguyen

ER Thoracotomy - SNguyen - ED Thoracotomy Scott Nguyen MD...

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ED Thoracotomy Scott Nguyen, MD Elmhurst Hospital Center July 27, 2005
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ED Thoractomy Definition: Thoracotomy performed in the Emergency Department for resuscitation of patients arriving in extremis.
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Procedure – Left Anterolateral Thoracotomy
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Clamshell Thoracotomy
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Purpose
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Release Pericardial Tamponade
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Control Intrathoracic Hemorrhage
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Eliminate massive air embolism or bronchopleural fistula Post intubation & positive pressure ventilation Get air transfer across traumatic alveolovenous channels Pulmonary hilar cross clamping Air aspirated from L ventricular apex and aortic root Cardiac massage
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Perform Open Cardiac Massage Bimanual internal massage with hands in a hinged clapping motion Ventricular compression proceeding from apex to base of heart
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Occlude Descending Thoracic Aorta
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Futile? Overall survival ~4-5% Little to Lose Exists a risk to Health care workers Risk blood contact 26% trauma pts HIV+ or Hepatitis+ Health care costs J Trauma. 1998 Jul;45(1):87-94
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