ED Thoracotomy

[roja]

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for ruptured AAA? (will even give you lost vitals in front of you)




Discuss

 

[southerndoc]

for ruptured AAA? (will even give you lost vitals in front of you)




Discuss

Chances of survival is probably pretty much zero with a AAA that's ruptured.

 

[DropkickMurphy]

for ruptured AAA? (will even give you lost vitals in front of you)




Discuss

What provoked this thread if you don't mind my asking?

 

[beyond all hope]

I presume you mean to cross-clamp the aorta.

I'm not sure that I would do it. I've never heard of anyone doing it, and the survival is near zero in that case, so why open yourself up to medicolegal nightmares doing experiments on dying people?

Maybe if I was in the boonies and I saw it rupture right in front of me. Maybe. Probably not.

 

[mikecwru]

for ruptured AAA? (will even give you lost vitals in front of you)




Discuss

I always thought that cross clamping for an abdominal catastrophe (even traumatic) was pretty much proven to be useless.

mike

 

[BKN]

I always thought that cross clamping for an abdominal catastrophe (even traumatic) was pretty much proven to be useless.

mike

My experience was that it gave you a chance to clamp/tear an esophagus in a dead person.😡

 

[southerndoc]

My experience was that it gave you a chance to clamp/tear an esophagus in a dead person.😡

... and get sued for causing their death when you clamp the esophagus.

(At least that's what the sharks will argue.)

 

[roja]

Happened somewhere. guy lived. (was done to cross clamp aorta.....)

Can't find anything in the literature.


Was curious about others ideas, thoughts, etc etc

 

[docB]

Maybe if I was in the boonies and I saw it rupture right in front of me. Maybe. Probably not.

I would argue that in the boonies is the wrong place to do a thoracotomy for any indication. By boonies I assume you mean rural ED with little surgical support. An ED thoracotomy might buy you a short period of time to get the pt from the ED to the OR but you'd have to have an OR, team and surgeon right then. If you're doing it and your OR is an hour away its usefulness is greatly diminished (from poorly useful to begin with).

 

[J.J.]

I saw a pt. yesterday who was flown in from a surrounding county who was involved in a drive-by shooting. SHe had multiple gunshot wounds to the chest and abdomen. At the outside hospital they performed a thoracotomy and cross clamped the aorta. She was flown- in after receiving 4 units of blood and 3 liters NS.
BTW, her heart was full and active on arrival, she was hypotensive, and bradycardic after three rounds of atropine. The super weird thing was she had a femoral pulse. Everyone was quite confused but she was taken to the OR none-the-less.... not sure if she survived or not.

 

[waterski232002]

How about thoracotomy for cardiac arrest of an acute pulmonary embolism? Anyone ever seen or heard of it actually being done?

 

[Dr. Will]

How about thoracotomy for cardiac arrest of an acute pulmonary embolism? Anyone ever seen or heard of it actually being done?

I don't know the specifics about the case, but I know it was done at Cook County while I was rotating through Cards.

 

[nocallaochicas]

How about thoracotomy for cardiac arrest of an acute pulmonary embolism? Anyone ever seen or heard of it actually being done?

On one of my aways, an attending said he had massaged a saddle embolus after watching a patient that was "highly likely" (can't remember the whole story) loose vitals right in front of him. He kinda implied he never thought he would see it or hear about it again.

ncc

 

[WakeMedHeel]

That's ummmm...sort of aggressive.

 

[Cric4U]

You know...it's interesting...at a point people are dying and will be dispo'ed to the (CCU) celestial care unit unless something is done. Where I am in training we had a blunt trauma victim loose pulses on the CT table. Emergent thoracotomy was performed and a ruptured RV with plugged with the attending trauma surgeon's finger until repaired in the OR. On my off service trauma rotation I later cared for this patient and watched him walk out of the Trauma Nursing Unit. Dramatic...life saving...truly the "art" of medicine. Remember that thoracotomy is "indicated" in penetrating trauma patients who loose pulses in front of you. However, this represents one of those things is medicine that will never be studied with a randomized controlled clinical trial. It's impossible. Clinical judgement is key. Remember...you can't make someone more dead. Screw the sharks! Take care!!!

 

[bartleby]

There are many good reasons not to perform futile procedures in the emergency department (excluding emergent thoracotomy in the setting of the penetrating trauma patient who codes in front of you), lawyers be damned. High on the list is that while you stand in a pool of blood with your arm in some dead guy's chest up to the elbow, your emergency department is going to **** as it fills up with people who may have something that you can successfully treat.

Remember...you can't make someone more dead. Screw the sharks!