January 13, 2013

• Squeezing a heart… literally

  The ultimate procedure in the ER is the open thorocotomy.  

  This is a procedure where you take a scalpel, and make an incision just below the nipple and continue all the way down the side of the body till you can’t go any further.  After that you insert rib spreaders and spread open the chest to find a problem as fast as possible.

  This procedure is quite rare since it is only done when a patient has a penetrating trauma (read as bullet to the chest) and loses vital signs in front of you.

  This recently happened to me.

  I actually won a writing contest a while ago writing about this.  Here is a link to that article if you want to read it.  But I have actually never seen it before.

  It was as intense as I had thought it would be.

  Granted the trauma surgeon really did everything while we resuscitated him (fluids, blood, epinephrine, compressions etc.)

   

  Did I mention the patient came in through the front door?

  Did I mention the patient was way too young for this to seem real?

  Did I mention that I visualized a heart with two holes in it, then they got sewn shut, then the heart started beating again?

  Did I mention how cool it seemed both at the time and after?

  Did I mention we placed paddles directly on the heart to defibrillate? 

  Did I mention that, unfortunately, the patient died…

   

  For how amazing the medicine was and how heroic all our efforts were, the end result was the expected tragedy of a person with a bullet to the heart.

   

  But, if it happens tomorrow, you better believe we’re going to try again, just in case that’s the one we can get back.

   

  This is a google image I found, but this is pretty much what it looked like, that’s the heart and lung there (minus the bullet holes)

   

   

  • 8:33 pm
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