The Stress of Open Thoracotomy

EPs frequently discuss the issue of low-volume, high-acuity procedures that we must be ready to perform, and there is no higher stress or professionally memorable procedure than the open thoracotomy. This is one of the most time-sensitive procedures, and is unquestionably the most invasive procedure in emergency medicine. Hesitating for even seconds will guarantee failure or a poor patient outcome. Nevertheless, no matter how grisly and stressful this procedure may be, it has real potential for saving lives.   Controversies continue to surround this procedure. It is relegated to the trauma team in most Level I trauma centers. Emergency medicine residents must compete with surgery residents for opportunities to learn the procedure. Unfortunately, the physicians who will be doing the majority of these procedures in the real world (emergency physicians, not the surgeons) often don’t get first billing when it comes to training.   Other procedural controversies include the risk of injuries to health care providers (exposure to contaminated blood products and lacerations from broken ribs or scalpel blades) and whether to write off all blunt trauma cardiac arrest patients (even though a number of case series show a small success rate). There is also controversy about the value and associated complications of cross-clamping the aorta.   These videos demonstrate the real-life tension and the common opportunities for improvement associated with this procedure.   Click...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs