Emergency Thoracotomy: Indications

When does a trauma patient in the ED need an emergent thoracotomy?

Accepted/relative indications
ANY  Penetrating thoracic injury
-Traumatic arrest, with or without previously witnessed cardiac activity
-Unresponsive hypotension (BP < 70mmHg)

Blunt thoracic injury
-Unresponsive hypotension (BP < 70mmHg)
-Rapid exsanguination from placed chest tube (>1500ml)
-Traumatic arrest with previously witnessed cardiac activity (relative indication)

Contraindications

- Blunt thoracic injuries with no witnessed cardiac activity

- Multiple blunt trauma

- Severe head injury

 

Source: http://trauma.org/archive/thoracic/EDTindications.html