When it comes to a medical emergency, the worst that we could think of is a Cardiac arrest. Millions of people all around the world are dying of this situation making it scary for each one of us.
Though this cannot be avoided in most situations, there is one way to treat this and that is called an emergency thoracotomy.
This was introduced in the year of 1900s since then it has become a matter of intense debate. It is said to be a very useful and last attempt method to save the life of an individual who is going through this emergency due to intense injury.
Though there is about a 60% positive survival rate, others have argued it to be an expensive procedure with significant personal risk.
If you are a medical professional, needing more opportunities for more knowledge and skill development in surgical operations especially with emergency Thoracotomy, then you can check the e-learning website Webop.com.
This is a website that was created and developed at the Department of Surgery at Witten/Herdecke University, Germany.
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Let us learn about the whole procedure of Emergency Thoracotomy:
The first thing required to do is to keep all the equipment required ready. This includes Gigli saw, a large scalpel, large clamp/ forceps, and large scissors.
Procedure
- Position the patient horizontally lying down with all the other requirements given like Intubation, ventilation, intravenous access, etc.
- Make sure that a rapid application of skin preparation is done.
- Then using a scalpel and blunt forceps, make a bilateral incision of about 4 cm in the 5th intercostal space in the mid-axillary line. If you find the cardiac output returns at this time, then stop the procedure right away.
- Then connect the thoracostomies with the skin incisions after you are done with the 5th intercostal space.
- Then with the help of two fingers you can hold on the lung aside, you can make an incision through all the intercostal muscles and the pleura using heavy scissors. This needs to be done on both sides leaving the sternal bridge between the two anterolateral thoracotomies.
- You can then cut through the sternum or xiphoid using heavy scissors or Gigli saw.
- Then with the help of a clamshell, spread open the retractors making the full chest cavity open to be seen.
- Then with the help of the clamp, lift the pericardium making a large midline longitudinal incision.
- Remove the blood clots and inspect the heart for any site of bleeding.
- In this situation, you need to check if the heart is beating with a return of cardiac output. If not then try to improve the cardiac output with supplementary cardiac massage and inotropic support
- At this stage, you need to make sure to control the bleeding.
- In the case of defibrillation, make use of internal paddles with an initial energy level of 10 joules.
Once the procedure is successful, the patient will begin to wake up and therefore immediate anesthesia will be required. Make sure to restore all the circulation and control bleeding associated with it.
It is very important that you keep a realistic expectation from this procedure. Because if the problem is very complex to tackle, then it will be difficult to handle it with this procedure.
