Emergency Department Thoracotomy Indications

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EDT is resource intensive and frequently futile. There is controversy regarding the procedure, with varying guidelines and reported survival rates.
Signs of life - pulse, bp, spontaneous respirations, reactive pupils, extremity movement, cardiac electrical activity
EAST guidelines for EDT
  1. Strong recommendation if pulseless w/ signs of life after penetrating thoracic trauma
  2. Conditional recommendation if
  •  Pulseless w/o signs of life after penetrating thoracic trauma
  •  Present OR absent signs of life after penetrating extrathoracic trauma
  •  Present signs of life after blunt trauma
    3. Recommendation against if absent signs of life after blunt trauma
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Exam world answers
  1. penetrating trauma w/ witnessed prehospital or ED arrest
  2. penetrating trauma w/ SBP <70 after fluid resuscitation
  3. blunt trauma w/ ED arrest
Why are you doing EDT?
1 - Cardiac tamponade release 2 - Cardiac massage 3 - Intrathoracic/cardiac hemorrhage control 4 - Cross-clamping descending aorta (optimize cerebral/coronary perfusion) 5 - Control air embolism
Sources
Wiki EM EM updates Medscape LIFTL
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