just did my first ER thoracotomy

[tussy]

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OK, i know you guys in the big trauma centres do these all the time, but up here in Canada there is little penetrating trauma (you've all seen the movie 'bowling for colombine' right??) . This is only the 4th er thoracotomy done here in the last 3 years (even though its a level 1 trauma centre and major referral centre)

So, to set the stage: I"m a PGY3, and just started doing senior call (usually don't do senior call until pgy4 year, but they were short on seniors this year, so i got bumped up). I got the panicked call from the ER at 7 pm - GSW to the chest, 2 minutes out, in cardiac arrest. We decided we would do the thorocotomy. Got the dusty thoracotomy tray off the shelf, donned the gown and gloves and did the deed.

There was a single, small calipre GSW to the R chest, just to the right of the sternum. No obvious exit wound. Did a left anterior thoracotomy - chest full of blood. opened pericardium - full of blood, large hole in RV. Sutured it closed. reached behind and felt another whole posteriorly - couldn't get to it. Extended the incision into the "clam shell" - closed the hole in the posterior heart.

Patient still died.

I'm still shaking. What a rush!!! It's midnight and the ER is now quiet. Gotta go home a try to get a little sleep before it picks up again.

 

[Daniel vD]

Did you 'enjoy' it?

In other words, was it 'fun' to do?

 

[Winged Scapula]

Congrats tussy!

We too get little penetrating trauma, even fewer of those are GSWs requiring thoracotomies. My BF, a resident at another program in town, not a Level I Trauma (like we are), has done several of them. He has the same reaction you seem to: excited, wants to talk about it over and over, etc.

I, OTOH, am dreading my first night of senior call for Trauma.

 

[maxheadroom]

Please, please, please, please NEVER let a patient need a thoracotomy when I'm on trauma call . . .

The horror, the horror . . .

 

[Spidey]

Kick as$ Tussy. Gratz on getting bumped to senior a year early btw

 

[njbmd]

Hey tussy,
Congratulations on the field promotion. With the new 80-hour work week restrictions here, second year took on a whole new meaning. There are new jobs added on even now.

Congratulation on the ER thoracotomy too! I haven't done one in the ER but I had to do two in the Cardiovascular ICU. Funny, but it was easier to go back into the chest than to get into the abdomen. Cleaned out the clots and both patients made it. Having a very experienced OR nurse come up to the unit to assist was a dream too! It was great fun but I know that shaking feeling after you are done.

njbmd

 

[pjr]

Don't worry, after the first 10 or so, the shaking stops. Remember: you can't make them more dead than they already are. Just make sure not to cross-clamp the esophagus (I nearly did that the first time) -- doesn't do much for the blood pressure.

pete

 

[DoctorDoom]

I did one on a patient more dead than alive, where my trauma chief figured I couldn't do any damage, and I still was shaking like a leaf afterwards.