Even then, the surgeon is getting a call when the chest gets cracked. Getting them to the OR quickly if you get a pulse back is required, so a nurse, tech, or secretary should be calling the surgeon anytime an emergent thoracotomy is being performed in the ED.Transvenous pacing is fun too... but there are more invasive procedures we do like chest tubes, cricothyrotomy, intubation, pericardiocentesis. But in general, ED Thoracotomy & Peri-mortem C-sections are the 2 most invasive procedures that are done in the ED by an Emergency Medicine Physician.
I love thoracotomies, but I trained at two big trauma centers and currently work in one and I´ve never seen anyone survive. I´ve seen at least fifty, probably closer to a hundred. Good way to get cut with HIV-HepC blood by a nervous intern. (still love ´em)
Never done or even seen a perimortem CS. Terrified that I might have to do one some day, although in theory it´s really quite simple. Low Trans incision, cut uterus, tear like crazy, deliver baby.
The best procedures are the simple, elegant ones. FB from kid´s nose by having mom blow in mouth. Reducing nursemaids, or reducing a shoulder with good technique.
I still love tubing people and putting lines in them, but I find as an attending I´m always trying NOT to do this to patients unless absolutely necessary.
Those untrained in doing C-sections should do the midline incision. We need as much exposure as we can get if we are going to be successful in this rescue procedure.The crash c-sections we do in the ED would be vertical midline big incision. did they change this recently?
The one procedure I hope to never do.BADMD made an excellent point.
I just described the procedure as I've seen it done. Just got back from doing some fieldwork in Guatemala and got involved in a fair amount of OB. This is the way I'd do it if I were standing over a patient with a jittery hand.
Might as well do a big X on the belly.
PS. anyone out here ever done a perimortem C?
Saw my first "exciting" C-section saturday. Luckily baby and mom were alright. The ob's hand was shaking for a bit when he started to suture the uterus together. After seeing that, I honestly don't think I would be able to handle a perimortem C/S very well.The one procedure I hope to never do.
I have done a number of thoracotomies (although not a big fan of them) and emergent surgical airways, etc etc and I hope I never have to do a perimortem c.
We did one last year at UofC (not me personally)...PS. anyone out here ever done a perimortem C?
What's the overlap between that book and Roberts & Hedges?A good handy book on procedures "Essential Emergency Procedures"
check it out.
They should add some color as well.I've always been a Roberts and Hedges guy but they've just gotta change all of their pictures. When you have that many pictures with ground glass syringes, people not wearing gloves, leeches, docs smoking at the bedside, injuries sustained while hand cranking a Model T Ford and so on it really detracts from the info.