CME 03/11/16 – Emergency Resuscitative Thoracotomy

Resuscitative Thoracotomy from SCGH ED CME

Here is Rosie’s talk on emergency resuscitative thoractomy.

Resources:

• An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

EAST updated its ERT recommendations in 2015 as follows:

1. In patients who present pulseless to the Emergency Department with signs of life after penetrating thoracic injury, we strongly recommend resuscitative Emergency Department thoracotomy.
2. In patients who present pulseless to the Emergency Department without signs of life after penetrating thoracic injury, we conditionally recommend resuscitative Emergency Department thoracotomy.
3. In patients who present pulseless to the Emergency Department with signs of life after penetrating extra-thoracic injury, we conditionally recommend resuscitative Emergency Department thoracotomy.
4. In patients who present pulseless to the Emergency Department without signs of life after penetrating extra-thoracic injury, we conditionally recommend resuscitative Emergency Department thoracotomy.
5. In patients who present pulseless to the Emergency Department with signs of life after blunt injury, we conditionally recommend resuscitative Emergency Department thoracotomy.
6. In patients who present pulseless to the Emergency Department without signs of life after blunt injury, we conditionally recommend against resuscitative Emergency Department thoracotomy

• Jeremy Mason’s talk on Resuscitative Emergency Thoracotomy 11/2015
• Mark Corden’s previous CME talk on Emergency Thoracotomy 7/2014
• John Iliff’s previous CME talk on Emergency Thoracotomy 10/2014
• Here is a good summary from LITFL titled “ED Thoracotomy: Is it Just the First Part of the Autopsy?” by Kane Guthrie
• Crack to Cure – ED Thoracotomy from EmCrit
• Clamshell Incision Versus Left Anterolateral Thoracotomy. Which One is Faster When Performing a Resuscitative Thoracotomy? The Tortoise and the Hare Revisited. Alexandros N. Flaris et al. World Journal of Surgery, May 2015, Volume 39, Issue 5, pp 1306–1311
• Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma-a review. Injury. 2006 Jan;37(1):1-19. is a great review article on the subject

Here are a some algorithms:

Here are the videos:

Here is a link to John’s slides and podcast from this great talk at SMACC 2015 via intensivecarenetwork.com