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Bullseye!! Transmediastinal GSW. Juan C Duchesne MD, FACS, FCCP, FCCM Associate Professor of Surgery Medical Director Tulane Surgical Intensive Care Unit Section of Trauma/Critical Care Surgery/Anesthesia/Emergency Medicine Spirit of Charity Hospital, New Orleans Louisiana.
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Bullseye!! Transmediastinal GSW Juan C Duchesne MD, FACS, FCCP, FCCM Associate Professor of Surgery Medical Director Tulane Surgical Intensive Care Unit Section of Trauma/Critical Care Surgery/Anesthesia/Emergency Medicine Spirit of Charity Hospital, New Orleans Louisiana
Inverse ratio 42:58 (Blunt: Penetrating) 4.9% severely injured with need of >10 u PRBC/24 hours (Average Nation 1-2%) (War 5-7%)
Bullseye!! Transmediastinal GSW • In North America, the first written thoracic operative record appeared in the diary of Cabeza de Vaca in 1635. • This account described the operative removal of an arrowhead from the chest wall of an Indian.
Bullseye!! Transmediastinal GSW • The majority of thoracic injuries can be managed non-operatively with tube thoracostomy. • Only 15% to 30% of the penetrating chest trauma require open thoracostomy. • Insertion of a tube thoracostomy is sufficient in treating 70% to 80% of trauma victims.
Bullseye!! Transmediastinal GSW Hemodynamically Stable YES NO Operating Room, or ED Thoracotomy DEVELOP a GAME PLAN! STUDY injury ANATOMY F.A.S.T. CT SCAN Angiogram Yeeeh ED Thoracotomy! ATTACK! TARGET SPECFIC
EFFECTIVE RESUSCITATION Permissive Hypotension
LVR PRBC FFP Cryo Platelets
Bullseye!! Transmediastinal GSW “DUCHESNE Algorithm” for Hemodynamically Unstable Transmediastinal GSW • Sterile techniques becomes a LUXURY! • ATLS • EFFECTIVE “LOW VOLUME RESUSCITATION!” • “Double Exhaust” Chest tubes • F.A.S.T • Thoracotomy on chest tube side with most Bleeding • Clamshell
Bullseye!! Transmediastinal GSW Hemodynamically Stable
Bullseye!! Transmediastinal GSW Hemodynamically Stable YES NO Operating Room, or ED Thoracotomy DEVELOP a GAME PLAN! STUDY injury ANATOMY F.A.S.T. CT SCAN Angiogram Yeeeh ED Thoracotomy! ATTACK! TARGET SPECFIC