IT'S THE HALLOWEEN SPECIAL, PART TWO! Ralph & Dr. Barker are joined by Dr. Daniel Liesen, who is here to discuss thoracotomies in the emergency department.     

Remember:
1. Know your indications and contraindications and ensure back up is available and on their  way.
2. Prepare your equipment
3. Incise and gain entry also intubate right mainstem and know how to use your spreaders!
4. LOOK!!!   
5. Control hemorrhage that is visible and open pericardium-control direct cardiac bleeding
6. Clamp the aorta above the diaphragm- Time is ticking.....
7. Open cardiac massage/defibrillation
8. Avoid further air embolism if any present
9. Got ROSC and adequate vital signs————-> To the OR
10. Always be careful please!

Below are some great instructional links and evidence based articles. 
             
https://emj.bmj.com/content/22/1/22

https://www.facs.org/-/media/files/quality-programs/trauma/publications/thoracotomy.ashx

https://litfl.com/resuscitative-thoracotomy/

https://www.east.org/education/practice-management-guidelines/emergency-department-thoracotomy

https://rebelem.com/if-youre-going-to-do-the-thoracotomydo-a-clamshell/

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiHnNHUzdvsAhWriK0KHcJ_B-UQwqsBMAF6BAgFEAM&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D924t8kpW-p4&usg=AOvVaw170N7m070KxjSCUWwAJRKY

https://www.uptodate.com/contents/resuscitative-thoracotomy-technique

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802990/