Teaching image withheldThe image will be revealed when it becomes clinically available in the case.

Operative image classified as OPERATIVE: an open left thoracic cavity during emergency resuscitative thoracotomy, with the lung and mediastinal structures exposed and instruments maintaining the operative field. The image supports the confirmed finding of an opened pericardium during traumatic arrest management; the exact rhythm and coronary anatomy are not independently established by the image. • TEACHING IMAGE

Trauma resuscitation / emergency thoracotomyHigh-energy motor-vehicle collision causing blunt thoracic trauma, traumatic arrest in the trauma suite, and immediate transfer to an adjacent operating room or operating-level resuscitation area for emergency resuscitative thoracotomy with pericardial opening.Advanced

Traumatic Arrest With Open Pericardium: Internal Cardiac Massage and Defibrillation

SCENARIO

A previously responsive adult is brought after a high-speed motor-vehicle collision. Initial resuscitation includes airway control, bilateral chest decompression as indicated by the trauma team, blood-product resuscitation, and rapid assessment for immediately reversible causes. The patient then loses pulses in the trauma suite. Because the patient is in traumatic arrest, the team proceeds directly to an adjacent operating room or operating-level resuscitation area rather than CT, initiates traumatic-arrest protocols, and performs an emergency resuscitative thoracotomy. The pericardium is opened, and the operative image becomes available during the procedure. The team now needs coordinated decisions about internal cardiac massage, rhythm assessment, and use of internal shock paddles.

← Previous case All cases Next case →