Surgery>>>>>Trauma
Question 6#

In which patient is emergency department thoracotomy contraindicated? 

A. Motor vehicle accident victim, cardiac tamponade seen on ultrasound, SBP decreasing to 50 mm Hg
B. Motor vehicle accident victim, became asystolic during transport with 5 minutes of cardiopulmonary resuscitation (CPR) with no signs of life
C. Patient with chest stab wound, SBP decreasing to 50 mm Hg
D. Patient with chest stab wound, became asystolic during transport with 20 minutes of CPR with no signs of life

Correct Answer is D

Comment:

The utility of resuscitative thoracotomy (RT) has been debated for decades. Current indications are based on 30 years of prospective data, supported by a recent multicenter prospective study. RT is associated with the highest survival rate after isolated cardiac injury; 35% of patients presenting in shock and 20% without vital signs (ie, no pulse or obtainable BP) are salvaged after isolated penetrating injury to the heart. For all penetrating wounds, survival rate is 1 5%. Conversely, patient outcome is poor when RT is done for blunt trauma, with 2% survival among patients in shock and < 1% survival among those with no vital signs. Thus, patients undergoing cardiopulmonary resuscitation (CPR) upon arrival to the ED should undergo RT selectively based on injury and transport time.