EMCrit Podcast 287 - Resus Thoracotomy with Dennis Kim
Dec 9, 2020
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Dennis Kim, trauma surgeon, discusses resus thoracotomy in trauma cases - emphasizing the importance of experienced hands, incision techniques, innovative approaches like riboa, managing great vessel trauma, medication use for resuscitation, and teamwork in resuscitative decision-making.
Hands-on experience crucial in traumatic injuries like gunshot wounds.
Collaborative efforts among Canadian trauma surgeons vital for trauma care network.
Invasive procedures like thoracotomies essential in rising incidents of interpersonal violence.
Importance of systematic evaluation and decision-making in resuscitative thoracotomy procedures.
Deep dives
Overview of Resuscitative Thoracotomy with Trauma Surgeon Dennis Kim
Resuscitative thoracotomy is discussed with trauma surgeon Dennis Kim, focusing on the importance of hands-on experience in traumatic injuries, especially penetrating traumas like gunshot and stab wounds. Dennis Kim shares his journey from Canada to the US to gain experience in severe traumas involving gun and knife injuries.
Discussion on the Trauma Surgeon Pipeline and Collaboration Among Canadian Surgeons
Canadian trauma surgeons like Dennis Kim and Kenji are highlighted for their work in trauma care and surgery. The collaborative efforts among Canadian trauma surgeons and physicians showcase a supportive network across the country, emphasizing the importance of sharing knowledge and experiences.
Importance of Invasive Procedures in Trauma Care
The podcast delves into the rising incidents of interpersonal violence and the need for invasive procedures like thoracotomies in trauma care. Trauma surgeons and emergency medicine providers collaborate to handle critical cases efficiently, ensuring prompt interventions for traumatic injuries.
Considerations for Resuscitative Thoracotomy Procedures
The discussion covers the procedural intricacies of resuscitative thoracotomy, including the orientation of the thoracotomy incision, the technique for cross clamping the aorta, and the delicacy of managing pulmonary and cardiac injuries during the procedure. The importance of systematic evaluation and decision-making in high-stress scenarios is emphasized.
Medications and Resuscitation Strategies in Traumatic Arrest
The podcast addresses medication strategies in traumatic arrests, focusing on the use of vasopressors like vasopressin and epinephrine, along with considerations for calcium and bicarbonate administration to manage severe acidosis. The discussion highlights the challenges and considerations in resuscitating patients with traumatic injuries.
Determining Endpoints in Resuscitative Thoracotomy
The podcast concludes with a discussion on when to cease resuscitative efforts during thoracotomy procedures, emphasizing the importance of teamwork, communication, and a systematic approach to decision-making. Factors influencing the decision to stop resuscitation efforts are explored, including patient viability, resuscitation algorithms, and team input.
Additional Contributions and Insights
The episode wraps up with a review of key procedural considerations, such as the use of Foley catheters for tamponade, the significance of manual occlusion in controlling bleeding, and the role of effective communication and teamwork in trauma resuscitation. Dennis Kim's practical insights and experiences in trauma care enrich the discussion on resuscitative thoracotomy procedures.
