Emergent Thoracotomy

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Sohail,

clam shell is entirely appropriate usually faster and better ie greater exposure allows for inflow occlusion.

Tom
> ----------
> From: 	Sohail Muzammil[SMTP:sohailmuzammil at hotmail.com]
> Reply To: 	Trauma & Critical Care mailing list
> Sent: 	sexta-feira, 4 de agosto de 2006 07:07
> To: 	trauma-list at trauma.org
> Subject: 	Emergent Thoracotomy
> 
> Grenade blast. mid twenties male with multiple pellet wounds. Significantly 
> Rt and Lt infraclavicular region, Lt parasternal, epigastric and suprapubic.
> 
> Combatative, shocked, air hunger. Rt chest tube 1800 ml blood. Rapid 
> downhill gasping as wheeled into theater. Arrested in theater.
> 
> Lt ant thoracotomy: Large clot and blood spurt as pericardium opened. 
> Puncture wound 3mm x 3mm in ant wall Lt vent closed. Heart revived with DC 
> shock and cardiac massage continued as thoracotomy converted to clamshell. 
> Arrest again. Massage continued
> 
> Exit wound in posterior wall of vent as well as exit into diaphragm seen. Rt 
> chest azygos v inj. Abdo: puncture through liver with trickle of blood. 
> Before post cardiac wound repair heart could not be revived. Patient 
> expired.
> 
> Total time from arrival to death declared 34 min
> Injury to arrival +/- 30 min.
> 
> Questions:
> 
> comment on choice of approach/extension
> Any other maneuver to get to the post wall of the heart from the left?
> Any other comments
> 
> Thanks in advance.
> 
> S Muzammil, FRCS
> Combined Military Hospital
> Lahore Pakistan
> 
> 
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