Young male with single stab wound to left upper thorax. Hypotensive en-route but loses output as they are wheeled through the door. What do you do...?

Firstly know how to get inside the chest (and do it promptly if indicated). And remember to split into two teams - the best thoracotomy in the world will not be successful unless team two simultaneously (and effectively) resuscitate the patient.

Its worth noting that some ED physicians prefer the 'straight to Clamshell' approach- in which case you would extend your incision bilaterally and use the trauma shears (or sternal saw if you have one), to divide the sternum (see 'Clamshell' section below).


So you've 'cracked' the chest. Now what the heck do you do?? The main goal for emergency physicians is to relieve cardiac tamponade if present. You do so and there is an incised wound in the left ventricle. Probably best to stick a finger ON the wound and await the surgeon. But what if they aren't coming? This is a 'you've nothing to lose' moment so if you're the best option then go for it..


Hannah Bell