Today, we turn back to a topic near and dear to my heart (pun always intended), resuscitative thoracotomy. I covered the basics of this in my:
Crack to Cure Lecture
If you have not seen that one, you should watch it first. Then come back here to listen to the conversation I had with Dennis Kim.
Dennis Kim, MD
Dennis is a trauma surgeon and intensivist at Harbor-UCLA. He was born and raised in Toronto, Canada & attended medical school at McMaster University. Following his general surgery residency, he completed a critical care medicine fellowship at the University of Ottawa. He then completed a fellowship in trauma & surgical critical care at UC San Diego. His passion for surgical education led me to complete a Masters in Medical Education at the University of Dundee. I’ve been a trauma surgeon at Harbor-UCLA Medical Center in Torrance, CA, since 2012.
He also runs the wonderful Trauma ICU Rounds podcast which you should check out ASAP if you are interested in Trauma and Surgical Critical Care.
Today we run through the entire thoracotomy procedure with tips, tricks and pitfalls.
Additional EMCrit Thoracotomy Stuff
- Podcast Crack to Cure ED Thoracotomy
- The Abbreviated ED Thoracotomy Tray
- John Hinds on Crack the Chest Get Crucified
- EMCrit 278 – Labors of Trauma – Blunt Edition (Part 1)
- EMCrit Podcast 36 – Traumatic Arrest(Opens in a new browser tab)
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- EMCrit 373 – Mike Weinstock with another Critical Care Bounceback: “Asymptomatic Hypertension” - April 18, 2024
- EMCrit Wee – Ross Prager on 10 Heuristics for the New ICU Attending - April 13, 2024
- EMCrit 372 – FoundStab Intubation SOP - April 5, 2024
So for non teaching (level2) trauma center could you direct me or explain the low vs high protoplasm? Help decide who to crack? Do you use SOL like pea or pupil? Do you do time of cpr?
Meant low vs high viability definition or guideline
Thank you for a great podcast! I have a question regarding a simular, but also different condition, cardiac tamponade from aortic dissection type A. I work with retrieval medicine and encounter patients with tamponade after aortic dissection, before an hour long transfer to a tertiary center for aortic repair. If these patients arrest, they do so because of tamponade, not because of exanguination. Is it futile to try to relieve the tamponade in an arrested patient with thoracotomy? I’ve been in this situation once, and the team tried pericardiocentesis, but were unable to aspirate enough blood due to clotting, so… Read more »
Scott.
my words cannot do this justice. this was incredible. I can only imagine working besides such teachers as you and Dennis Kim. I have only done a few thoracotomies, in my life, the last a clamshell after seeing one of your pods. they still scare the bejesus out of me. i’ll try to revisit the other 5 EMCrit pods on thoracotomy listed above. one of the most moving pods I’ve ever seen was third one by our friend and colleague John Hinds.
thank you so very much to you, and Dennis Kim.
tom
awesome ‘cast guys. a couple of minutia-level thoughts, for your consideration: on HEMS bithoracotomy vs LL, i do a hybrid: LL starting to the right of the sternum, plus a R finger thoracostomy. if i need further throacotomization (neologism), i connect the R finger thoracostomy to the sternal incision and take down the sternum. having a R thoracostomy also avoids me being blind to what’s going on in the R hemithorax. the finger slide: i slide the index finger of my cutting hand along the intercostal space so i can mentally map out the curvature prior to making my incision.… Read more »
nice!!
That works. Every thoracotomy I do ends up with my hand passing through the anterior mediastinum to open up the right pleural space to decompress it and rule out a massive right hemothorax or tension ptx.
Though this topic is way above my scope of practice, I enjoy listening every single podcast. I try to bring these practices to bedside( not talking about thoracotomy for sure) .Thank you for sharing the wealth of knowledge and bringing awesome Guests as well Scott.
3 Thoracotmies a day and Living in Redondo Beach, CA. Harbor-UCLA EM was the best place to train (fewer when I was there). Dr Kim is an amazing addition to an all-star crew.
Love having you on EMRCRIT, Great talk!!
[…] SpoonfulFirst, you must watch EMCrit’s Crack to Cure video. Next, the Thoracotomy Masterclass. Also, if you want to see how great Essentials of EM is, check out this video on performing a […]