Have you ever seen an ED thoracotomy?

[TexasTriathlete]

After making an appearance at a party for about an hour last, I decided to go help out at the trauma center. It ended up being about a 10-hour volunteer shift.

It was dead up until about 2AM, when suddenly, EMS started encoding one after another. At one point, we were about half full in crash, with 18 traumas of one kind or another on the way.

One dude came in with a stab wound to the chest. The doc did the ultrasound and it showed a ton of fluid around the heart. Pericardial effusion, maybe? I can't remember exactly what they were saying, but the dude was ****ed up.

Now, as a volunteer, I understand that I don't fully know what the hell I'm doing, but I do have some things to offer during a trauma stat, so I try to walk the fine line of being nearby enough to help, and still be out of the way so the pros can do their job. Mostly, I am tall, so I can reach **** hanging off the ceiling. I also know where stuff is, so if someone yells out for a 10cc syringe, 4x4's, fluid, etc., I like to be the one to get that stuff for them, because the other people in there don't need to waste their time with that kind of thing.

During something like this, I'm zoned in. I just try to keep my eyes and ears open to see if there is anything I can do to help, and to make sure I'm not getting in anyone's way. So after the doc does the ultrasound and says "get me that thoracotomy tray!" I'm thinking "holy ****".

So I grab the tray out of the cabinet and set it down on the stand by him. Now this is something I really want to see, but this patient is still (sort of) conscious. So at this point, I'm hoping that we can just get this dude to surgery before it comes to that.

We get him hooked up to the level 1 transfuser, the guy is intubated and zonked out, and then the surgeon shows up and says they're ready to roll. Another near-miss: I still have yet to see them crack the chest in the ER.

Now obviously, if nobody ever had to get an ER thoracotomy from now until the end of time, I would be fine with that. But its going to happen, and when it does, I want to be there to see it. I want to see as much freaky stuff as I can before school starts, so that I am not distracted as much by the "wow" factor when I finally see it in rotations.

A few minutes after they went to surgery, the surgeon's student shows up... "did someone page a trauma stat?"

I hope I'm never that guy.

So I found out that the dude made it through surgery, which is nice. Not sure what the prognosis is at this point, but obviously a lot better than if they had done it in the trauma bay.

So anyone here actually seen this done, like in a volunteer shift or anything?

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[USArmyDoc]

After making an appearance at a party for about an hour last, I decided to go help out at the trauma center. It ended up being about a 10-hour volunteer shift.

It was dead up until about 2AM, when suddenly, EMS started encoding one after another. At one point, we were about half full in crash, with 18 traumas of one kind or another on the way.

One dude came in with a stab wound to the chest. The doc did the ultrasound and it showed a ton of fluid around the heart. Pericardial effusion, maybe? I can't remember exactly what they were saying, but the dude was ****ed up.

Now, as a volunteer, I understand that I don't fully know what the hell I'm doing, but I do have some things to offer during a trauma stat, so I try to walk the fine line of being nearby enough to help, and still be out of the way so the pros can do their job. Mostly, I am tall, so I can reach **** hanging off the ceiling. I also know where stuff is, so if someone yells out for a 10cc syringe, 4x4's, fluid, etc., I like to be the one to get that stuff for them, because the other people in there don't need to waste their time with that kind of thing.

During something like this, I'm zoned in. I just try to keep my eyes and ears open to see if there is anything I can do to help, and to make sure I'm not getting in anyone's way. So after the doc does the ultrasound and says "get me that thoracotomy tray!" I'm thinking "holy ****".

So I grab the tray out of the cabinet and set it down on the stand by him. Now this is something I really want to see, but this patient is still (sort of) conscious. So at this point, I'm hoping that we can just get this dude to surgery before it comes to that.

We get him hooked up to the level 1 transfuser, the guy is intubated and zonked out, and then the surgeon shows up and says they're ready to roll. Another near-miss: I still have yet to see them crack the chest in the ER.

Now obviously, if nobody ever had to get an ER thoracotomy from now until the end of time, I would be fine with that. But its going to happen, and when it does, I want to be there to see it. I want to see as much freaky stuff as I can before school starts, so that I am not distracted as much by the "wow" factor when I finally see it in rotations.

A few minutes after they went to surgery, the surgeon's student shows up... "did someone page a trauma stat?"

I hope I'm never that guy.

So I found out that the dude made it through surgery, which is nice. Not sure what the prognosis is at this point, but obviously a lot better than if they had done it in the trauma bay.

So anyone here actually seen this done, like in a volunteer shift or anything?

Without knowing more than you described, it sounds like the guy had a cardiac tampanode where basically the pericardial sac starts to strangle the heart. The pressure inside the ventricles and atria overcome the venous return pressure therefore affecting diastolic filling. In turn, the patient goes into shock and muti-organ failure leading to death.

Obviously, this patient had a trauma to the chest (i.e. stab wound to the chest) hence the reason they did the ultra sound. Once they saw the fluid around his heart, you can do a pericardiocentisis but considering he was stabbed and you do not know exactly where the bleeding is coming from it becomes a surgery thing. Why crack the chest open in the ER when you can do it in the OR?

Beck's Triad would be there: Systemic Hypotension, Quiet Heart Sounds, and Jugular Venous Distention. You would also get a pulsus paradoxus which is a drop in 10-15 mmHg in arterial pressure when the patient inspires. However, given the circumstances I doubt they even had time to do all this and just paged surgery stat based upon the results of the U/S.

Read about it man......everytime I see a case I read about it and learn from it. Also, I obviously never managed a case like this so I am going by what I would do.

To answer your question....yes I did see this happen. The patient was stabbed four times and the trauma surgeon cracked his chest open right in front of me and started massaging his heart. I just stared.

 

[igcgnerd]

seen 2
The first one was a gang banger with a GSW to the chest dropped off by a homeboy ambulance in the ambulance bay. He lost consciousness as we were putting him on a gurney so we rushed him to the trauma and he lost his pulse. Doc did a thoracotmy and I happened to be next to him but he neglected to tell me to watch my feet and blood poured onto my scrub pants. The guy probaly had almost a liter of blood in the chest. PT expired.
The second one was last week and ironicly enough was another walk in gsw to the chest and neck. This guy however made it to the OR and to the SICU alive and stable.

 

[igcgnerd]

Just wanted to mention since this is the pre osteo forum, one of the docs that did a thoracotomy was a DO

 

[tkim]

Saw several during my rotations. The most I saw was three in one night during a shift at LAC-USC. Seven unrelated shootings in one shift. It was sick. Housekeeping was in C-booth (trauma bay) with the mop and bucket every hour.

 

[superfan56]

To answer your question....yes I did see this happen. The patient was stabbed four times and the trauma surgeon cracked his chest open right in front of me and started massaging his heart. I just stared.

old schools doc's do this for cardiac arrests i think as well.

 

[TexasTriathlete]

DO's are better suited to do this procedure, because massaging the heart is a type of OMM. DO's treat the whole heart. Not just the pericardium.

 

[USArmyDoc]

DO's are better suited to do this procedure, because massaging the heart is a type of OMM. DO's treat the whole heart. Not just the pericardium.

Of course, think about your chapman's points.

Also man, maybe you should just take it easy and relax. Give yourself some rest before you enter this $hit show called medical school.

 

[USArmyDoc]

old schools doc's do this for cardiac arrests i think as well.

Yea, the patient went into cardiac arrest due to shock and organ failure. Crazy right?

 

[TexasTriathlete]

I can't relax because I work full-time, and have for almost 3 years straight. Hell, I worked while in school too, but only about 20-30 hours/week.

School > Work

My return to school cannot get here soon enough. Especially since I'm about to start working about 60 hours/week.

 

[USArmyDoc]

I can't relax because I work full-time, and have for almost 3 years straight. Hell, I worked while in school too, but only about 20-30 hours/week.

School > Work

My return to school cannot get here soon enough. Especially since I'm about to start working about 60 hours/week.

I hear ya man. I worked three jobs in college as well and volunteered etc.....However, looking back and if the circumstances permitted I would of taken some time off and went on a vacation or something. Now, I am just an obsessed medical student reading everything out there....Good luck

 

[TexasTriathlete]

Vacations cost money. So do things like rent, bills, 30+ medical school applications, interview trips, moving to Atlanta, car payments, and so-on.

I don't think I will be doing much relaxing this spring/summer. I had plenty of fun this past year, but that doesn't seem to be in the cards this year.

 

[TexasTriathlete]

Once they saw the fluid around his heart, you can do a pericardiocentisis but considering he was stabbed and you do not know exactly where the bleeding is coming from it becomes a surgery thing. Why crack the chest open in the ER when you can do it in the OR?

I think he just wanted the tray ready to go in case he needed to do it. It was never his intention to go right in there.

 

[Dr JPH]

My uncles best friend is a radiologist and he told me once that...

Oh wait...wrong thread.

 

[TexasTriathlete]

If you want to continue this here, that's fine. I never said anything about my uncle's best friend. I'm talking about clients of mine, and people I see socially and professionally, and have spoken with specifically about such things. If you want to narrow it down to an academic context, one is an attending trauma surgeon at a level II trauma center who I know very well, and another is a former program director for an internship program at the Texas Medical Center in Houston. I keep getting the same stories, but now there's a resident on the internet who tells me I am getting bad information, but won't explain why. I'm still waiting.

 

[Dr JPH]

If you want to continue this here, that's fine. I never said anything about my uncle's best friend. I'm talking about clients of mine, and people I see socially and professionally, and have spoken with specifically about such things. If you want to narrow it down to an academic context, one is an attending trauma surgeon at a level II trauma center who I know very well, and another is a former program director for an internship program at the Texas Medical Center in Houston. I keep getting the same stories, but now there's a resident on the internet who tells me I am getting bad information, but won't explain why. I'm still waiting.

Wait all you want my friend. I would hate to ruin your impression of the osteopathic profession. With any luck you will soon be one of us, and perhaps develop a thought of your own.

 

[Dr JPH]

Oh, and knowing people with fancy titles and **** doesnt impress me (or anyone else for that matter)

I know more people than you do.

 

[J1515]

My uncles best friend is a radiologist and he told me once that...

Oh wait...wrong thread.

Stop trying to rip off my signature line.

 

[TexasTriathlete]

I'm not sure you actually understand what I'm saying. Or you are ignoring the point because you just want to tell me that I'm wrong.

If I am wrong, fine. I'm always up for learning something new, or at least another perspective on the matter. And with all the time you've wasted cluttering up the place with telling me that I'm wrong, you could have easily made your point instead, if you really do have one.

 

[Dr JPH]

I'm not sure you actually understand what I'm saying.

5 months and 2500 posts and you finally got it right.

 

[dizzle69]

DO's are better suited to do this procedure, because massaging the heart is a type of OMM. DO's treat the whole heart. Not just the pericardium.

WTF??

 

[TexasTriathlete]

No offense, but if you took that seriously, even for just a fraction of a second, you need to kill yourself.

 

[dizzle69]

No offense, but if you took that seriously, even for just a fraction of a second, you need to kill yourself.

I'm not the one preaching this bull**** in every post and sounding like a douche ranting about Dr. X and Dr. Y's experiences that you've never truly experienced yourself. Food for thought, nice to know you'll be THE 2nd rate doctor with the advice you give.

Psychiatry anyone?

 

[TexasTriathlete]

I haven't talked about anyone else's experiences. I am merely passing on advice that was given to me by reliable sources. And the fact that you're getting mad at me for questioning if you took my blatantly ridiculous statement seriously is just as stupid.

 

[dizzle69]

I haven't talked about anyone else's experiences. I am merely passing on advice that was given to me by reliable sources. And the fact that you're getting mad at me for questioning if you took my blatantly ridiculous statement seriously is just as stupid.

So, you admit what you posted was stupid? Nicely done.

NEXT! (In case you don't get it, I'm done ).

 

[TexasTriathlete]

It was stupid on purpose. More specifically: facetious. And obviously so. Except to you.

Anyone feel free to get back on topic.

 

[FinchHead]

It's called sarcasm drizzle. He was trotting out a tired old cliche (D.O.'s treat the whole person...) in a rediculous way to make fun of it.

What is that vapid comment supposed to mean anyway? Anyone who says they like D.O. because they treat the "whole" person needs their applications shredded.

 

[Dr JPH]

Anyone who says they like D.O. because they treat the "whole" person needs their applications shredded.

Says the premed.



You guys ****ing crack me up.

Why dont premeds stick to what they know? MCAT Prep and kissing ass for letters of recommendation?

 

[HillMill]

And maybe you should consider removing yourself from the PRE-Osteopathic forum... just a thought

 

[Dr JPH]

And maybe you should consider removing yourself from the PRE-Osteopathic forum... just a thought

Ah yes...have one of the only people who can actually provide correct information and insight leave you premeds to yourselves.

Now how much sense does that make?

Do you honestly think that a bunch of pre-DOs sitting around answering eachothers questions is a good idea?

What is the point of coming here to ask questions of people who are IN THE SAME POSITION AS YOU?

So HillMill...YOUR solution is NOT to try to improve the quality of information being passed along, but rather to ignore the advice from those with significantly more experience and focus on the ignorant and incorrect information that is being regurgitated.

I have a better idea! Maybe the premeds here should LISTEN to those of us who have EXPERIENCE and KNOWLEDGE about certain topics instead of insisting they are correct. I know it sounds crazy, but it just might work.

Or, of course, you could just sit around with the other wannabe med students and mentally masturbate over things you know nothing about. Your choice.

Im doing all of you a service by posting here. You may not like my attitude or my methods of conveying information, but lets face it...Im a hell of a lot better than listening to others who are applying...Im a hell of a lot better than your "uncles best friend who knows a DO"...Im a hell of a lot better than the pre-allo/allo students who want to rip on everything osteopathic.

Everyone is always so concerned about "talking to real DOs and seeing what they say."

Well I AM a DO. Here I am...willing to answer real questions and willing to offer insight.

But no...youre saying that I should leave the pre-DO forum so that no one hears the truth...so that premeds can answer other premeds questions.

Instead of "thanks JP for correcting me", I am asked to leave.

Perhaps you want to rethink your above post.


Oh, and HillMill...youre welcome.

 

[IDBasco]

-Multiple rational thoughts-

Not all of the pre-meds wish you gone.

 

[Dr JPH]

Not all of the pre-meds wish you gone.

Then tell some of these knuckleheads to keep their mouths shut and their ears open...or better yet, let them fall to the wayside.

Theyre not the type of people you want as classmates anyway.

 

[tkim]

Hey all.

Keep asking questions, it's the only way to get them answered.

If I can answer them I will. If I can't, I'll say so.

 

[USArmyDoc]

Vacations cost money. So do things like rent, bills, 30+ medical school applications, interview trips, moving to Atlanta, car payments, and so-on.

I don't think I will be doing much relaxing this spring/summer. I had plenty of fun this past year, but that doesn't seem to be in the cards this year.

Alright, I was just passing on some info based on experience. I am not saying you should stop working. You seem to have a little bit of an attitude and think you are something you are not. Of course, I can also be misinterpreting you.

Good luck with school and maybe put the attitude that I know a lot to the way side. You allude to a prior carreer so you probably DO know alot. However, when it comes to medicine that is only going to get you in trouble. We had some kids in our class try to tell the docs how to teach and they didn't fly well. They showed us that on the next exam.

 

[Dr JPH]

Alright, I was just passing on some info based on experience. I am not saying you should stop working. You seem to have a little bit of an attitude and think you are something you are not. Of course, I can also be misinterpreting you.

Good luck with school and maybe put the attitude that I know a lot to the way side. You allude to a prior carreer so you probably DO know alot. However, when it comes to medicine that is only going to get you in trouble. We had some kids in our class try to tell the docs how to teach and they didn't fly well. They showed us that on the next exam.

Wait until they get to rotations. For some reason the "I think I know more than I do" syndrome persists...and they REALLY get hit hard. (by pissed off residents like me! )

 

[Jpc984]

Does that mean that the people who say "I don't think I know enough" are golden? That would probably be me!

 

[IDBasco]

Then tell some of these knuckleheads to keep their mouths shut and their ears open...or better yet, let them fall to the wayside.

Well, since I'm the type to give people all the rope they need, I'll just keep quiet.

 

[TexasTriathlete]

US Army: you are drawing conclusions that aren't really there. I'm a cocky guy, but nothing more. There are some things I know pretty well, but I don't see myself as having much of an advantage going into school. Maybe with a little of the anatomy stuff, but not on the level that it will make a big difference. If you're talking about my dismissing your advice as having an attitude, then sorry. Believe me, if I had the money, I'd quit work and go on a 6 month vacation right now. But at this point, thanks to applying and traveling and things along those lines, I am pretty much living paycheck-to-pacheck now. It sucks ass, and I would like to start school ASAP for this reason, among others.

Dr JPH: sometimes you offer good advice, and it is appreciated. Other times, you criticize people's statements, with no knowledge of the context of the statements, and you also offer no actual advice on why they are wrong. Believe it or not, I am not just pulling advice out of my ass here. I am a pretty social guy, and I know a lot of docs, and I am not shy about asking them for advice. I am also as old as, or older than a lot of them, so they seem to look at me a little differently than they do other pre-meds, and are typically pretty open and willing to help me with my career change into medicine.

So you ask me where I get this crap. I tell you, and it doesn't matter, because I didn't experience it myself. You've told people that you're tired of giving the same advice over and over, and to do a search of your posts. So I did, and all I can really gather is that you're a PGY-1 at a PCOM surgery program who is a self-proclaimed "bad test-taker" and likes to talk ****. That's nice and all, but it doesn't really teach me anything useful. If this is how you let off steam after work or studying for your PGY-1 test that you're so worried about, that's fine. I don't take SDN to be more than it is, and the internet is a great way to unwind. But I have friends who have been to PGY-1 and beyond, at allopathic and osteopathic schools. Hell, I'm about to go to work, and if I go in there and throw a rock, I'd probably hit a PGY-1. I'll be glad to take advice from you when you actually offer it. You are potentially a great resource for the people on this board. But I'm surrounded by good resources who give me advice all the time, so forgive me if I pass along something that they told me that happens to be different from what you've experienced. If you'd say how it was different, that would be even better. Anyway, good luck on your exam.

 

[t-funk]

Alright, I was just passing on some info based on experience. I am not saying you should stop working. You seem to have a little bit of an attitude and think you are something you are not. Of course, I can also be misinterpreting you.

Good luck with school and maybe put the attitude that I know a lot to the way side. You allude to a prior carreer so you probably DO know alot. However, when it comes to medicine that is only going to get you in trouble. We had some kids in our class try to tell the docs how to teach and they didn't fly well. They showed us that on the next exam.

I really don't think this type of attitude or behavior is limited to non-trads in any way, shape, or form. There are plenty of people out there who tend to act like they know everything even w/o much experience; this can be especially true for a traditional type who has never received anything but straight As and a high MCAT. I've had what I would consider 'a great career on a resume' and tend to know a lot more than anyone ever realizes bc I'm quiet and don't talk a lot, especially when I'm trying to learn more info and I'm always respectful of the instructor. I think you have got a few non-trads individual personalities confused with some sort of trend and are making inapropriate generalizations.

 

[superfan56]

we all kind of got sidetracked here huh?

 

[Jack Daniel]

...Im doing all of you a service by posting here. You may not like my attitude or my methods of conveying information, but lets face it...Im a hell of a lot better than listening to others who are applying...Im a hell of a lot better than your "uncles best friend who knows a DO"...Im a hell of a lot better than the pre-allo/allo students who want to rip on everything osteopathic.

Everyone is always so concerned about "talking to real DOs and seeing what they say."

Well I AM a DO. Here I am...willing to answer real questions and willing to offer insight.

But no...youre saying that I should leave the pre-DO forum so that no one hears the truth...so that premeds can answer other premeds questions.

Instead of "thanks JP for correcting me", I am asked to leave.

Perhaps you want to rethink your above post.


Oh, and HillMill...youre welcome.

I think I've heard this speech somewhere before:

Son, we live in a world that has walls, and those walls have to be guarded by men with guns. Whose gonna do it? You? You, Lt. Weinburg? I have a greater responsibility than you could possibly fathom. You weep for Santiago, and you curse the marines. You have that luxury. You have the luxury of not knowing what I know. That Santiago's death, while tragic, probably saved lives. And my existence, while grotesque and incomprehensible to you, saves lives. You don't want the truth because deep down in places you don't talk about at parties, you want me on that wall, you need me on that wall. We use words like honor, code, loyalty. We use these words as the backbone of a life spent defending something. You use them as a punchline. I have neither the time nor the inclination to explain myself to a man who rises and sleeps under the blanket of the very freedom that I provide, and then questions the manner in which I provide it. I would rather you just said thank you, and went on your way, Otherwise, I suggest you pick up a weapon, and stand a post. Either way, I don't give a darn what you think you are entitled to. ​

 

[smq123]

A few minutes after they went to surgery, the surgeon's student shows up... "did someone page a trauma stat?"

I hope I'm never that guy.

You probably will be, at some point. I know it sounds pessimistic, but unless you're willing to camp outside the resident's call room, you're probably not going to get to see everything. (And no resident is going to let you follow him around EVERYWHERE, like a puppy dog.)

I want to see as much freaky stuff as I can before school starts, so that I am not distracted as much by the "wow" factor when I finally see it in rotations.

So many pre-meds (and pre-pre-meds) say this, and I really cannot understand why. Why do you want to ruin half the fun of third year? Your main compensation, as a third year, IS the "wow factor." Otherwise, there is absolutely no point in getting up at 4:00 in the morning.

As a third year, your role on the team is very, very minimal. If you're an "honors" student, then you won't be dead weight. That's it - you don't make the opening incision, often times you won't do the closing sutures. You won't be putting in orders or drawing labs. If you're really lucky, they'll let you put a foley in! (With a nurse breathing down your neck, waiting to pounce.)

Even if you protest "But I've seen this all before," your resident will just shrug his shoulders, roll his eyes, and say, "So? So have I." Just because you've seen it before doesn't mean that your resident will let you do the ex lap yourself, or let you singlehandedly fix the aorta.

So, practically your only compensation as a third year is the fact that you get to see as much crazy stuff as possible. What's wrong with the "wow factor"? That's what kept me motivated through 12 weeks of surgery and surgical sub-specialties.

(Pssst - the wow factor can even boost your grade as a third year. Residents and Attendings like enthusiastic, interested students. If you've already seen a lot of this stuff before, and therefore can't get enthused or interested, they'll write something like "student looked like he had mentally checked out," and your grade will go thumbdown very quickly.)

So, sure - volunteer if it makes you happy. But keep some surprises for third year!

 

[spicedmanna]

I think this thread has been maxed out and sufficiently sidetracked. The tiresome back and forth has made sure of that. My plea to you all is that if you just want to beat your chest and have nothing of value to discuss that is ON TOPIC, please resist the urge to do so. While this isn't an issue of TOS violation, it is a question of professionalism, and this is a professional forum. Keep that mind.

I'm closing this thread.