A resuscitative thoracotomy (sometimes referred to as an emergency department thoracotomy (EDT), trauma thoracotomy or, colloquially, as "cracking the chest") is a thoracotomy performed to resuscitate a major trauma patient who has sustained severe thoracic or abdominal trauma and who has entered cardiac arrest because of this.[1] The procedure allows immediate direct access to the thoracic cavity, permitting rescuers to control hemorrhage, relieve cardiac tamponade, repair or control major injuries to the heart, lungs or thoracic vasculature, and perform direct cardiac massage or defibrillation. For most persons with thoracic trauma the procedure is not necessary; only 15% of those with thoracic injury require the procedure A resuscitative thoracotomy is indicated when severe injuries within the thoracic cavity (such as hemorrhage) prevent the physiologic functions needed to sustain life. The injury may also affect a specific organ such as the heart, which can develop an air embolism or a cardiac tamponade (which prevents the heart from beating properly). Other indications for the use of this procedure would be the appearance of blood from a thoracostomy tube placed that returns more than 1000-1500 mL of blood, or ≥200 mL of blood per hour.[citation needed] For resuscitative thoracotomy to be indicated, signs of life must also be present, including cardiac electrical activity and a systolic blood pressure >70 mm Hg.[2][3] In blunt trauma, if signs of life, such as eye dilatation, are found en route to the hospital by first responders, but not found when the patient arrives, then further resuscitative interventions are contraindicated; however; when first responders find signs of life and cardiopulmonary resuscitation time is under 15 minutes, the procedure is indicated.[4] The use of a focused assessment with sonography for trauma may be performed to determine the need of the procedure by finding free floating fluid in the thoracic cavity.[

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