Emergency thoracotomy is a critical surgical procedure performed for life-threatening chest injuries, addressing conditions such as pericardial tamponade and massive hemorrhage. There are specific types, indications, and contraindications, with various surgical approaches and potential complications. Proper management following surgery, including chest drain monitoring, is vital for recovery.

1. Combined Military Hospital Dhaka
By Capt Shams
Emergency Thoracotomy

2. Emergency Thoracotomy
Introduction
Types
Indications
Contraindications
Approaches
Complications
Conclusion

3. • Emergency Thoracotomy is an open surgical technique
carried out as an intervention for life threatening chest
injuries.
Introduction

4. • Emergency department thoracotomy or sternotomy:
• Performed immediately
• At the emergency department
• Planned emergency thoracotomy:
• Following diagnosis of a specific injury
• At the operation theatre
Types

5. Indication
• Pericardial tamponade
• Control of haemorrhage from intra thoracic injury
• Initial haemorrhage > 1500 ml through chest tube
• Ongoing haemorrhage > 200 ml/h over 3-4 hours
• Systolic BP < 70 mmHg despite resuscitation
• Control of massive air leak
• Clamping of the thoracic aorta
• Open cardiac massage
• Control of air embolism

6. Indication
• Pericardial tamponade
• Control of haemorrhage from intra thoracic injury
• Initial haemorrhage > 1500 ml through chest tube
• Ongoing haemorrhage > 200 ml/h over 3-4 hours
• Systolic BP < 70 mmHg despite resuscitation
• Control of massive air leak
• Clamping of the thoracic aorta
• Open cardiac massage
• Control of air embolism

7. Contraindication
• CPR in absence of intubation > 5 minutes
• CPR despite intubation > 10 minutes
• Blunt trauma with no sign of life

8. Approaches
• Left anterolateral thoracotomy
• Right anterolateral thoracotomy
• Clamshell incision
• Median sternotomy

9. Complications
• Injury to the surrounding structures
• Left phrenic nerve, coronal vessels, etc.
• Bleeding
• Infection
• Complications related to chest drain

10. •A chest drain is kept in situ following the surgery
and is monitored regularly to assess the post
operative recovery.
•Emergency thoracic surgery is an essential part of
the skill of any surgeon dealing with major trauma.
Conclusion