How is the patient prepared for thoracotomy to treat hemothorax?

Updated: Jul 13, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Jeffrey C Milliken, MD  more...
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Answer

Volume resuscitation should be performed according to ATLS protocol and should be continued en route to the operating room. Some forethought must be given to the availability of blood products if needed rapidly.

Anesthesia should be started rapidly, and all maneuvers should be employed to prevent aspiration. Although a double-lumen endotracheal tube is a very useful luxury to have in thoracic surgical cases, it is only absolutely necessary in a few cases and should not be considered unless it can be placed without delaying the operative procedure. Standard endotracheal intubation is adequate in most cases.

At least two secure large-bore intravenous lines must be established before surgery so that fluids and blood products can be administered rapidly if needed. An arterial line should be placed, but central intravenous access is not an absolute necessity, and surgery should not be delayed for such procedures. Pulse oximetry and the end-tidal carbon dioxide value should be monitored during the procedure.

If stability of the spine or other skeletal structures has not been fully determined before exploratory thoracotomy, every effort must be made to maintain proper support and stabilization of these structures when positioning the patient for thoracotomy.

In hemodynamically unstable patients, volume resuscitation must be maintained during the administration of any anesthetic agents because further instability and hypotension may ensue with anesthesia induction.

A dose of intravenous antibiotics should be administered before emergency exploration. Generally, a broad-spectrum cephalosporin is advisable. If thoracoabdominal injury is present and bowel injury is considered, coverage for gastrointestinal tract organisms should be added.

Conservation of patient body temperature in trauma surgery is extremely important. A variety of surface-warming devices are available and can be used to cover the patient, leaving only the operative field open. Warmers should also be used for intravenous crystalloid and blood products. Raising the ambient temperature in the operating room may be necessary. Maintenance of body temperature is extremely important to prevent complications such as coagulopathy and cardiac arrhythmias.


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