With respect to the trauma patient:
a) List the key clinical signs of traumatic asphyxia. (30% Marks)
b) Explain the term resuscitative thoracotomy. Give the indications for and contra-indications to resuscitative thoracotomy in patients with acute chest trauma. (70% Marks)
The key clinical signs to indicate a patient has sustained traumatic asphyxiation include:
Resuscitative thoracotomy is a procedure of last resort that is nearly always performed in the emergency department and involves gaining rapid access to the heart and major thoracic vessels through an anterolateral chest incision or clam shell incision to control exsanguinating haemorrhage or other life-threatening chest injuries
What are the indications for resuscitative thoracotomy?
Contraindications to resuscitative thoracotomy
This SAQ was not passed by anybody, which again brings into question the utility of asking trainees about such esoterica as traumatic asphyxia or pyroglutamic acidosis. Does one's inability to discuss these topics really act as a sensitive discriminator to tell "junior consultant" from "competent senior registrar"?
a) "Traumatic asphyxia" is defined as "a form of suffocation where respiration is prevented by external pressure on the body". It is essentially a crush injury of the thorax, with impaired respiration as the result of greatly decreased chest expansion. Failure of venous return from the upper body results in the characteristic clinical findings, all of which can be attributed to greatly increased venous pressure. This list of signs is composed on the basis of articles by Byard et al (2006) and Eken et al (2009)
b) Resuscitative thoracotomy is defined as a left-sided clamshell thoracotomy performed for the specific purpose of gaining rapid access to the heart and major thoracic vessels.
Indications for resuscitative thoracotomy (Rabinowici et al, 2014)
Contraindications for resuscitative thoracotomy
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Rabinovici, Reuven, and N. Bugaev. "Resuscitative thoracotomy: an update." Scandinavian Journal of Surgery (2014): 1457496913514735.
CALS program manual: "Emergency Thoracotomy (Circulation Skills 4)"
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