Pleural decompression with subsequent tube thoracostomy is one of the most 
commonly performed life-saving procedures for traumatic chest injuries. 
Thoracic injuries are primarily responsible for 25% of all trauma deaths 
and contribute to a further 25% of deaths. However, over 85% of patients 
with thoracic trauma do not require thoracic surgery.

Pleural Decompression & Drainage

Learn more about life, limb and heroic critical care procedures in the emergency department &amp; retrieval environment

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Prehospital limb amputation is an uncommonly performed procedure whereby 
amputation of an entrapped limb is required to facilitate the safe 
extrication of a patient in a life-threatening situation.

Retrieval Amputation

Resuscitative hysterotomy is the emergent delivery of a foetus from a 
mother in cardiac arrest to improve the outcomes of both the mother and 
foetus.

Questions covered include:

    * Is the 4 minute rule really valid?
    * What are the technical steps in performing the procedure?

Resuscitative Hysterotomy - Peri-Mortem C-Section

Most fatalities from blunt or penetrating cardiac injuries occur prior to 
hospital arrival. The main reversible pathology is acute cardiac tamponade, 
which may be present without external signs of injury, abnormal clinical 
signs, or ECG abnormalities. The cause of the tamponade is usually a 
laceration to a low-pressure cardiac cavity. In recent years the widespread 
use of ultrasound in the initial assessment of severely injured patients 
has facilitated the early diagnosis of cardiac tamponade and associated 
cardiac injuries.

Pericardial Decompression - Resuscitative Thoracotomy

Escharotomy involves incision of inelastic burned tissue (eschar) that can 
impair perfusion of the extremities, as well as restrict chest wall 
movement and ventilation.

Indications:

    * Limb hypoperfusion
    * Ventilation restriction

Limb Hypoperfusion

Can occur with circumferential AND non-circumferential burns.

Escharotomy

Temporary transvenous cardiac pacing involves insertion of a pacing wire 
(catheter based electrode) into the right ventricle to allow electrical 
stimulation of the myocardium.

Transvenous pacing is usually attempted in the emergency department after 
less invasive treatments have been unsuccessful.

Pleural Decompression & Drainage

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