Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.
Emerg Med Australas. 2010 Aug;22(4):332-6. doi: 10.1111/j.1742-6723.2010.01303.x.
A low case incidence and variable skill level prompted the development of a credentialing programme and specific surgical training in resuscitative thoracotomy for emergency physicians at The Alfred, a Level 1 Adult Victorian Major Trauma Service.
A review of the incidence of traumatic pericardial tamponade and the objectives of resuscitative thoracotomy were undertaken.
A training programme involving pre-reading of a 17 page teaching manual, a 40 min didactic lecture and a 2 h surgical skills station using anaesthetized pigs were developed. The specific indication for resuscitative thoracotomy for this programme is ultrasound demonstrated cardiac tamponade secondary to blunt or penetrating truncal trauma in a haemodynamically unstable patient with a systolic blood pressure of less than 70 mmHg despite pleural decompression and intravenous volume replacement. Cardiac electrical activity must be present. The primary aims of resuscitative thoracotomy taught are release of cardiac tamponade, control of haemorrhage and access for internal cardiac massage.
Emergency physicians working in high-volume Trauma Centres are expected to diagnose cardiac tamponade and on occasion decompress the pericardium. Specific training in the procedure should be undertaken.
由于病例发生率低且技能水平参差不齐，因此在 1 级成人维多利亚重大创伤服务的阿尔弗雷德医院为急诊医师制定了创伤性心脏压塞的认证计划和专门的剖胸术培训。
回顾创伤性心包填塞的发生率和剖胸术的目的。
制定了一项培训计划，包括阅读 17 页的教学手册、40 分钟的理论讲座和使用麻醉猪的 2 小时手术技能站。该方案中进行剖胸术的具体适应证为超声显示钝性或穿透性躯干创伤继发心脏压塞，且在进行胸腔减压和静脉补液后血流动力学仍不稳定的患者，收缩压低于 70mmHg，且必须存在心脏电活动。剖胸术的主要目的是解除心脏压塞、控制出血和便于进行心脏内按摩。
在高容量创伤中心工作的急诊医师应能够诊断心脏压塞并在必要时解除心包填塞。应进行该手术的专项培训。
