Kostick Nathan, Gray Sanjiv, Huynh Dustin
Medicine, University of Central Florida College of Medicine, Orlando, USA.
Surgery, University of Central Florida College of Medicine, Orlando, USA.
Cureus. 2020 Dec 4;12(12):e11907. doi: 10.7759/cureus.11907.
This report reviews the indications and complications of resuscitative thoracotomy in the trauma patient as seen with the clinical course of a 19-year-old male who experienced postoperative pericardial tamponade after a bilateral resuscitative thoracotomy with pericardiotomy. This patient presented to the hospital in critical condition with 31 gunshot wounds (GSWs) distributed over the chest, abdomen, and extremities. After undergoing an initially successful resuscitative thoracotomy, the patient continued to bleed into his chest at a greater rate than the chest tubes were able to adequately evacuate. Despite the presence of a large pericardial window, clotted blood led to cardiac tamponade. Subsequent bedside reopening of thoracotomy under conscious sedation (ketamine, fentanyl, and midazolam) was required to evacuate the clots and stabilize the patient. This case provides the opportunity to discuss several interesting points for managing the traumatized patient, including indications for resuscitative thoracotomy, use of conscious sedation for bedside major surgery, and complications of clamshell thoracotomy, and ethics of resource allocation.
本报告回顾了创伤患者复苏性开胸手术的适应证及并发症，这些情况可见于一名19岁男性患者的临床病程中，该患者在双侧开胸复苏并心包切开术后出现了术后心包填塞。该患者因胸部、腹部和四肢有31处枪伤（GSW），在病情危急的情况下被送往医院。在最初成功进行复苏性开胸手术后，患者胸腔内出血速度超过胸腔引流管的充分引流速度。尽管有一个大的心包开窗，但凝血导致了心脏填塞。随后需要在清醒镇静（氯胺酮、芬太尼和咪达唑仑）下在床边再次开胸，以清除血凝块并稳定患者病情。该病例提供了一个机会，来讨论处理创伤患者的几个有趣要点，包括复苏性开胸手术的适应证、在床边进行大手术时使用清醒镇静、蛤壳式开胸手术的并发症以及资源分配的伦理问题。
