Emergency Thoracotomy Guidelines

This guideline provides information on the resuscitative thoracotomy process in the Emergency Departments at Dunedin and Southland Hospitals.

Most patients with blunt thoracic trauma do not require surgery and are managed either with chest drainage and/or ventilatory support of some sort. Of those that do need an operation , the vast majority can be transferred rapidly and safely to the operating room.

Patients with penetrating trauma more commonly need surgical intervention but this should also be done in the operating theatre whenever possible.

Occasionally patients present in extremis with refractory shock or lose signs of life in, or just prior to arrival to, the Emergency Department. Some of these patients (notably those who have cardiac tamponade from a stab or other low energy penetrating wound) may survive if an Emergency Department thoracotomy is done and we need to be prepared for such an event, even though it is rare. An algorithm to guide decision-making is presented in Appendix 1.