department thoracotomy is a life-saving procedure in
a select group of patients. Exactly who these patients
are is a matter of some controversy in the trauma literature.
There is a significant amount of published data on the
indications for and outcomes of resuscitative thoracotomy.
However the results of interventions varies widely,
as does each unit's experience, puclished data ranging
for 11 patients in 10 years to 950 patients in 23 years.
studies give little indication as to what has gone before
(apart from physiological data). Prehospital data such
as time of injury, paramedic on-scene time and time
in the emergency department prior to thoracotomy are
rarely given. The use of prehospital manoeuvers that
may worsen outcome, such as external chest compressions
and large volume fluid resuscitation, are also not routinely
published. Similarly, the indications for performing
surgery are not uniform and inconsistently applied,
or not recorded at all. There are only 3 prospective
studies in the literature.
article discusses the indications for emergency department
thoracotomy and describes the operative technique as
well as resuscitative management of these patients.
Emergency department thoractomy is performed in the
emergency room for patients in extremis due to