Emergency Bedside Thoracotomy - A Life-Saving Intervention in Critical Situations

Introduction

An emergency bedside thoracotomy is also called a resuscitative thoracotomy or, at times, referred to as an emergency department thoracotomy or EDT. There are several other names for emergency bedside thoracotomy, such as trauma thoracotomy, colloquially, and cracking the chest. An emergency bedside thoracotomy is generally performed in order to resuscitate a significant event of trauma that the patient has met and has sustained a severe thoracic concussion and abdominal dismantle and eventually has entered the state of cardiac arrest because of the severity of the patient’s current condition. The procedure of emergency bedside thoracotomy allows the healthcare provider to have immediate and direct access to the thoracic cavity of the patient, thus permitting the rescuers and the professional to have strong control over the ongoing hemorrhage, as well as relieve any kind of cardiac tamponade by repairing and controlling the major injuries to the vital organs such as the heart, lungs, and the thoracic vasculature. A direct cardiac massage is then performed, or defibrillation may also be used. For the majority of the patients suffering from thoracic trauma, the procedure of emergency bedside thoracotomy is not at all necessary.

What Are the Indications of an Emergency Bedside Thoracotomy?

An emergency bedside thoracotomy or a resuscitative thoracotomy is only indicated when the severity of the injuries within the thoracic cavity is preventing the smooth physiologic functions of life, such as a severe case of hemorrhage in the cardiovascular system. Such an injury may additionally affect a vital organ such as the lung or the heart, which may eventually develop an air embolism or even a cardiac tamponade, which will prevent the heart from beating smoothly. The other indication for the emergency bedside thoracotomy would be the clear appearance of blood because of a thoracostomy tube that has been placed inside and returns more than 0.39 gallons of blood in an hour. Another requirement is the sign of life that can be reflected in the cardiac electrical activity diagnostic tools. The presence of systolic blood pressure of more than 70 mm Hg is an additional compulsion to perform this procedure. Mentioned below are a few of the clinical manifestations of the present that are additive to the above-mentioned indicative factors to perform emergency bedside thoracotomy.

• Restlessness.

• Chest pain that radiates to the neck and left shoulder.

• Deep inhalation becomes very strenuous.

• Shortness of breath that leads to rapid breathing.

• Striking pulse rates.

• Large visible veins on the neck.

• Sudden loss of consciousness.

• No pulse.

• Not able to breathe.

• Sudden collapse.

• Discomfort in the chest.

• Weakness.

• Palpitations.

• Fluttering feeling in the chest.

• Pounding of the heart.

• Rapid heartbeat.

• Irregular heartbeat.

• Wheezing.

• Shortness of breath.

• Dizziness.

• Lightheaded.

• Abnormal breathing patterns.

• Nausea.

• Vomiting.

• Fatigue.

• Constant pain in the belly.

• Deep pain in the side of the abdomen.

• Back pain.

• Pulsation near the navel.

• Fever.

• Generalized palpitations.

• Pain in the lower part of the legs.

• Clammy skin.

• Profuse sweating.

• Increased heart rate.

• Difficulty while swallowing.

• A drastic drop in blood pressure.

• Coughing.

• Hoarseness of voice.

• Pain in the upper back.

• Discomfort in the jaws.

• Flank over the kidneys.

• Ripping or tearing feeling in the abdomen.

• A noticeable bulge in the chest or the abdomen.

• Bluish discoloration of the lips and nails.

How Is Emergency Bedside Thoracotomy Performed?

The procedure of an emergency bedside thoracotomy was first got into the picture by Schiff in late 1800 in conjunction with an open cardiac massage. Shortly after this, emergency bedside thoracotomy was used by Block for the treatment of heart lacerations and injuries, and thus the first suture repair was performed in the mid-1900. However, before the process of external defibrillation usage and cardiopulmonary resuscitation came into the picture in the year 1960, the process of an emergency bedside thoracotomy was already the preferred way and planned for the treatment of an episode of cardiac arrest. Out of all the kinds of emergency bedside thoracotomy, a left anterolateral thoracotomy is one of the most common methods of opening or cracking the chest. This is because this particular kind provides rapid access to the heart and can also be easily extended within the right side of the chest. Thus, it is basically able to provide access to almost all of the vital anatomical structures of the cardiovascular system during the process of resuscitation of the patients. Mentioned below are the steps that occur during the procedure of an emergency bedside thoracotomy.

• An initial incision is first made that runs along the fourth or even the fifth intercostal space- known as the space between the ribs, the intercostal muscles, and the parietal pleura.

• After opening up this space, the ribs are smoothly retracted in order to provide excellent access and proper visualization.

• After the incision has been made in such a manner that it covers both the right as well as left areas, it is known as a clamshell bedside thoracotomy.

• The clamshell bedside thoracotomy is usually done when there is only a right-sided pulmonary trauma or a vascular injury or even when there is a greater amount of access needed or better visualization is required.

Conclusion

Emergency bedside thoracotomy is known by several different kinds of names, with cracking open the chest and resuscitative thoracotomy being the well-known term. This is an invasive attempt and treatment or management option only for a particular set of individuals who have received severe trauma that is destroying or hampering the normal functioning of the vital organs of the body. There are several requirements that the patient must clear from the point of view of a healthcare professional that makes the patient eligible to undergo an emergency bedside thoracotomy. It should be noted that because of the vast invasiveness of the nature of the procedure, only a less percentage of patients survive after completion. In contrast, others may develop certain complications and infections related to the vital inner organs.