Which is not an indication of thoracotomy ?
Ans is 'b' ie Pulmonary contusion Indications of thoracotomy after chest trauma a) Cardiac arrest (resuscitative thoracotomy) b) Massive hemothorax (drainage of more than 1500 ml of blood when chest tube is first inseed or continuous haemorrhage of more than 200 ml/hr for more than 3 consecutive hours). c) Brisk bleeding (> 100 ml/15 min) d) Penetrating injuries of the anterior chest with cardiac tamponade. e) Large open wounds of the thoracic cage. f) Rupture of the bronchus, aoa, esophagus or diaphragm. Non emergent indication of thoracotomy a) Empyema not resolved with tube thoracostomy b) Clotted hemothorax c) Lung access d) Thoracic duct injuries e) Tracheoesophageal fistulas f) Chronic sequelae of vascular injuries (pseudo aneurysms & AV fistulas) Such an exhaustive list is prepared by mixing all the three books. (Shwaz, Sabiston, Bailey) Still Massive Pneumotharax has not been listed here (but Bailey & love, 23/e, p 765 gives the t/t of pneumothorax. If pneumothorax is not responding to initial conservative methods then thoracotomy and pleurectomy can be done.)
Massive pneumothorax
Pulmonary contusion
Bleeding more than 200m1/hr. in thoracotomy tube
Oesophageal rupture