October 15, 2020

Background: A resuscitative thoracotomy is a time-critical high acuity, low occurrence (HALO) procedure – as an emergency physician you need to know how to do it, but depending on your practice environment, it may be a once-in-a-career maneuver. All the more reason that, if you have to do it, you want to make sure your effort counts. In a prior post, I advised that if you’re going to be doing a thoracotomy as an EM doc, you should do a clamshell approach. This was based both on some evidence from the surgical literature as well as personal experience – I feel the clamshell gives you the exposure you really need if you are doing this rarely and the time difference compared to an anterolateral approach is negligible. A recent paper from Newberry et al. (published ahead of print in Annals of Emergency Medicine) addresses this very issue – from an EM perspective.

April 18, 2019

Every now and again someone raises the issue on social media about resuscitative thoracotomy.  What are the indications (we have the EAST guidelines for that), what are the risks (highlighted in this important recent paper), and of course, whether EM or surgery should be doing it in the trauma bay (guess what – it’s in the curriculum for both specialties). That’s not the point of this post.  This post is about how I think you, as the emergency medicine physician (EP), working in a system where your surgeon is not in-house, but is available in a reasonable amount of time, should proceed when faced with the patient who meets the indications.  You’ve gone through your HOTTT(T) algorithm and are now at that final “T” – you have to open the chest.