Traumatic Cardiac Arrest: ED Thoracotomy Instructions 1. CALL FOR HELP. 2. GATHER SUPPLIES. +/- Sterile gloves, towel, chlorhexidine Thoracotomy Tray For opening: Scalpel + Scissors, Finochietto retractor (spreaders) For sternum: Sternal saw, Lebsche knife & mallet, or shears For inside: Clamps, Forceps, Needle driver, Sutures 3. GET INTO CHEST. If-time, make strile: Gloves, chlorhexidine, towels. Make cut: Scalpel, 4cm at 4th ICS, along rib, skin + subcut Extend cut: Scissors, up to sternum, down towards axilla. Use 2 fingers to protect the lung, cutting over hand. Open up: Retractor. Hand crank & long bar are lateral. Repeat on other side. Cut sternum: Sternal saw, trauma scissors. 4. INSIDE THE CHEST: Correct reversible pathology: bleeding, obstruction. Highest survival rate after isolated cardiac injury. Evacuate Pericardium Repair Laceration on heart Cardiac Massage Cross-Clamp Aorta Intrathoracic Hemorrhage Air Embolism Dr. Sarah Foohey @SarahFoohey #Thoracotomy #Instructions #procedure #emergency #trauma #checklist #thoracic
