paolo fontana emergency life – saving thoracic operations chirurgia toracica venezia – mestre...

PAOLO FONTANA

EMERGENCY LIFE – SAVING THORACIC OPERATIONS

CHIRURGIA TORACICA VENEZIA – MESTREDirettore V. Pagan

Reversal of physiologic exhaustion by haemostasis and contamination control, to allow SUBSEQUENT definitive surgery

Thoracic DC in muribunds may require temporising CHEST/ABDOMEN lesions manageable by delayed operation AND performing immediate FASTEST and SIMPLEST definitive repair of intrathoracic lethal injuries

DAMAGE CONTROL(DC)

Thoracic Surgery Venice - Mestre

DC IN UNSTABLE PATIENTS

SECURE AIRWAY / VEIN

EMPIRIC TRANSFUSION

DIAGNOSTIC CHEST TUBE

US + CXR no delay

PERICARDIAL EVACUATION

EMERGENCY THORACOTOMYThoracic Surgery Venice - Mestre

ET PRIORITIES


CARDIAC MASSAGE

TAMPONADE RELEASE

AORTIC CROSS - CLAMP

HAEMORRHAGE CONTROL DIGITAL / FOLEY / CLAMPDIGITAL / FOLEY / CLAMP VASCULAR SHUNT / LIGATIONVASCULAR SHUNT / LIGATION SUTURE, STAPLE HEARTSUTURE, STAPLE HEART

PROPER TRACH TUBE PLACEMENT

R. ATRIUM / AORTA TUBING

HILAR CLAMP / TWISTING PULM GREAT VESSELS / BRONCHIAL CONTROLPULM GREAT VESSELS / BRONCHIAL CONTROL AIR EMBOLISMAIR EMBOLISM

OTHER ET MANEUVERS


STERNAL/CONTROLATERAL CHEST/CERVICAL/ABDOMEN INCISIONAL EXTENSION

LUNG STAPLING, TRACTOTOMY, RESECTION (STAPLED)

FAST VASCULAR, DIAPHRAGM, TRACHEA REPAIR

N-G SUCTION ESOPH TEAR + MEDIASTINAL TUBES

CHEST PACKING (LOOSE CLOSURE)

• THORACIC COMPARTMENT SYNDROME (+/- ABDOMINAL)

• CHEST TUBE STOP: ECHO!

• BLEEDING: MISSED SOURCE? COAGULOPATY? RE-EXPLORATION? (“6 IN 6” RULE)

• REPERFUSION SYNDROME POST AORTIC CLAMP RELEASE

• RISK FOR THE SURGEON

ET COMPLICATIONS


ET INDICATIONS UNRESPONSIVE HYPOTENSION DUE TO INFRATOHORACIC HAEMORRHAGE

AIR EMBOLISM OR TAMPONADE OR CARDIAC HERNIA EVIDENCE

C-P ARREST POST PENETRATING INJURY (S of L EVIDENT BEFORE ARRIVAL)

POOR PROGNOSIS FOR BLUNT INJURY AND NO S of L


LIFE SIGNS

CLASS I: NO SIGNS

CLASS II: ECG ACTIVITY +/- PULSE OR BP

CLASS III: BP<60mmHg AND TRANSIENT OR NO RESPONSE TO FLUIDS


ET SURVIVAL4620 PTS

CLASS I + II PENETRATING: 11-30%

BLUNT: 1-3%

Am. Coll Surg. 2000Thoracic Surgery Venice - Mestre

1976 – 2009 1871pts

ET/THORACOTOMIES 46/253

CLASS II BLUNT ET 33

overall SURVIVAL 5 / 33 ABD +/- THOR INJ 1/15 (6%)

THOR INJ ONLY 4/18 (22%)


(15%)

ET PROGNOSTICATORS

NO CLEAR SINGLE INDEPENDENT PROGNOSTIC FACTOR

S of L IN THE FIELD AND ET WITHIN 15min FROM CLASS II OCCURRENCE IN ALL SURVIVORS


Thanks to:Thanks to:V. Pagan

A. Zaccaria

F. Lo Giudice

A. Ferronato

M. Tisba

F. Messina

paolo fontana emergency life – saving thoracic operations chirurgia toracica venezia – mestre...

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