Abstract
It is 5 pm on New Year’s Eve and you are on service as an emergency physician in training for the London Helicopter Emergency Medical Service (HEMS). The London Ambulance Service Control informs you of a stabbing incident in the town of Watford, England. Your helicopter arrives on the scene 10 minutes after the call and 13 minutes after the incident, along with land ambulance and police. After the scene is declared safe, you are directed to the patient, JJ, a 24-year-old male who has suffered a stabbing outside of a local bar. His friend, who made the call to EMS, tells you JJ lost consciousness about 3 minutes after the insult. The patient has no signs of life, with no palpable carotid pulse or measurable blood pressure. He is apneic and his pupils are fixed and dilated. You notice a 2-cm wound in the midclavicular line, just superior to the left nipple, consistent with a penetrating stab wound. Cardiac monitors are attached and show an initial rhythm of asystole. Closed cardiac massage is undertaken immediately with rescue breaths given using bag-valve-mask. Simultaneously, the patient is cannulated in both antecubital fossae and is administered 1 mg adrenaline with 1000 mL 0.9% saline. Emergent decompressive needle thoracotomy is performed on the left chest by placing a 14-gauge, 3.5-inch angiographic catheter into the chest cavity at the midclavicular line in the second interspace. There is no release of air but periodic bubbles and blood appear to come from the left lung. After 2 minutes of unsuccessful CPR, there is still no palpable pulse and you notice the patient’s neck veins are distended, with normal air entry and no dullness to percussion in the left hemithorax. Your helicopter is about 10 minutes away from the nearest major trauma centre.
Highlights
The thoracotomy, perhaps one of the most invasive interventions in modern medicine, involves making a surgical incision along the chest wall to gain access to the organs of the thorax for purposes of treatment, examination, and/or removal
The procedure is utilized in the context of a patient in extremis or cardiac arrest due to thoracic trauma, with the primary objective of restoring cardiac output, organ perfusion, and minimizing exsanguinating hemorrhage.[1,2,3,4]
The collection of such techniques is termed a resuscitative thoracotomy (RT), which was first successfully performed by Ludwig Rehn in 1896 on a young gentleman dying of cardiac tamponade from a right ventricular stab wound.[1,2]
Summary
The thoracotomy, perhaps one of the most invasive interventions in modern medicine, involves making a surgical incision along the chest wall to gain access to the organs of the thorax for purposes of treatment, examination, and/or removal. US guidelines by the American College of Surgeons (ACS) Committee on Trauma only recommend EDT in patients enduring penetrating cardiac injuries with witnessed signs of life.[11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
