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.
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.