What You Need To Know About The Procedure Resuscitative Thoracotomy
When it is a matter of life and death, one thing that we all need to do is to act immediately. Similarly, when it is about a dangerous life situation like a chest haemorrhage or any other chest injury, it becomes very important to get to the emergency department and get quick treatment. One such treatment that we are going to talk about here is the resuscitative thoracotomy.
What is a Resuscitative Thoracotomy?
This is a thoracotomy or you can say a surgical incision that we do in the chest wall, that is mainly performed in the emergency department of a hospital. It is said to be an integral part of the initial resuscitation of a patient.
As e-learning has become very popular nowadays, we have this platform named “Webop” which has helped many to get practical knowledge about surgical operations through an online reference or an e-book. If you are looking to learn more about this resuscitative thoracotomy, you can check this website for more information.
This procedure is mainly used in cases where there are:
- Penetrating chest
- With isolated chest trauma or cardiac injuries
- Abdominal trauma
- When there is a loss of vitals
- While exsanguinating from the chest tube
The survival rate of an individual with this procedure is about 4 to 33%. But it all depends on the mechanism of injury, the location of the injury or any absence of vital signs.
For example, in the case of a chest haemorrhage, the risk of death will increase when the chest tube output exceeds about 1500 ml within 24 hours.
What is the Procedure of Resuscitative thoracotomy?
In case of a traumatic arrest, the first thing is to perform the resuscitation. This includes:
- First is intubating to reverse the hypoxia
- Next is to insert the bilateral chest drains or thoracotomies
- Perform resuscitative thoracotomy
- Limit the fluid flow as it might worsen the situation unless you got the haemorrhage controlled
- Also, limit the inotropes and pressors until the circulation is re-established.
The goal of this procedure is to:
- Relieve the cardiac tamponade
- Perform the open cardiac massage
- Block the aorta to increase the blood flow to the heart and the brain
- Have control over the life-threatening thoracic bleeding
- Have control over the broncho venous air embolism.
The next steps that need to be performed include:
- To perform the full aseptic technique
- With the help of a scalpel, make an incision through the skin and the intercostal muscles to the mid-axillary line
- Insert a heavy-duty scissor through the thoracostomy incisions
- Lift the clamshell
With this, you will relieve the tamponade and repair all cardiac wounds. Stop any kind of lung or hilar bleeding with a finger. Identify any aortic injuries and consider performing aortic cross-clamping at the level of the diaphragm.
To conclude, an ongoing haemorrhage without shock is the most common indication to perform the thoracotomy procedure. This is due to the penetrating injury which is not unusual to happen after the blunt trauma. Especially if there is thoracic bleeding of about 1500ml within 24 hours. It is perfect to be applied for both penetrating and blunt trauma.
