Thoracotomy for MRCEM
SURGICAL APPROACH TO THE THORAX
- Knowledge of the key structures implicated in anterolateral or posterolateral thoracotomy or median sternotomy
- Candidates will be expected to know the anatomical disposition of structures routinely divided during thoracotomy and the nearby structures which are also at risk
indications
- penetrating injury + arrest + previous signs of life
- blunt injury + arrest + previous signs of life
LITFL:
best outcomes in:
- penetrating chest
- those exsanguinating from chest tube
- isolated chest trauma
- cardiac injuries
- abdominal trauma/extra-thoracic haemorrhage that benefits from aortic clamping/manual occlusion
- time since loss of vitals – generally cited as <10 minutes since penetrating, <5 minutes since blunt
contraindications
- Penetrating injury + no signs of life and CPR > 10min
- Blunt injury + no signs of life > 5 minutes
- Multiple severe blunt trauma
- Non-survivable head injury
landmarks
5th intercostal space, mid-axillary line
anatomy
Muscle divided:
- pectoralis major
- pectoralis minor
- serratus anterior