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Trauma Procedures
Contents:
In the above photo a ventricular stab wound is being sutured Emergency Department Thoracotomy is only indicated when there is an experienced surgeon and should usually be restricted a pre-arrest or arrest situation following penetrating trauma. The key to success is pre-arrival preparation. Call for back-up. Open the thoracotomy tray. Check you have the necessary equipment: Scalpel with 10 or 20 blade, Finnocetto Rib Spreading Retractor, Lung Retractor, Aortic Clamp, Needle Holder, Silk or Nylon Suture. The incision is an antero-lateral thoracotomy, with the level depending on the suspected injury. After introducing the rib spreader and retracting the lung, the pericardium should be incised longitudinally to expose the heart without injuring the phrenic nerve. Identify the injury, place your finger in the hole to stop the bleeding, take a sliver of pericardium to use as a pleget on the suture, carefully close the laceration. You may only get one go so take the last step slowly. Once you have control, stop and have a breather. Be careful not to handle the heart excessively or you will tear it yourself. A tip for a good night's sleep is to look for and tie off the internal mammary you divide on the way in.
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