@trauma_timeabout 7 years ago

Emergency Thoracotomy

Today’s case we have this thoracotomy for everyone to enjoy! First, let us orient ourselves; head of patient, to the right side, and feet to the left side of the picture. This young patient sustained a stab wound to his mid chest via a long knife, which can be seen to the left of the thoracotomy. Unfortunately, the knife made it through his chest wall, perforating the left ventricle of the heart. This part of the heart pumps oxygenated blood, received from the pulmonary veins/left atrium, to the rest of the rest of the body, though the aorta. This procedure was done in the OR, due to the fact his blood pressure was more than likely completely tanked upon arrival to the trauma bay. Thoracotomies are usually done as a last ditch effort in attempts to resuscitate the patient who is completely cardiac arrested. An incision is made on the left lateral chest, exposing the 4th and 5th ribs. The pectoralis muscles and intercostal muscles are cut and the ribs are retracted, exposing the heart. With the heart exposed, you are able to quickly suture up any lacerations of the heart and manually pump the heart (aka an open cardiac massage). You can actually see the sutures that were placed right next to the surgeon’s thumb. Thoracotomies are considered last ditch efforts due to the fact that patients do not end up surviving, even with this aggressive intervention. Unfortunately, this patient did not end up surviving this trauma. The outcome of this procedure should not reflect the skill and hard work the entire team puts into this effort. You may know the gloomy outcome when going into this procedure, however, you have to have optimism that the patient you are working on may fall into the 1%, and pull through to have a thriving life!