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Juan C Duchesne MD, FACS, FCCP, FCCM Associate Professor of Surgery

Bullseye!! Transmediastinal GSW. Juan C Duchesne MD, FACS, FCCP, FCCM Associate Professor of Surgery Medical Director Tulane Surgical Intensive Care Unit Section of Trauma/Critical Care Surgery/Anesthesia/Emergency Medicine Spirit of Charity Hospital, New Orleans Louisiana.

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Juan C Duchesne MD, FACS, FCCP, FCCM Associate Professor of Surgery

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  1. Bullseye!! Transmediastinal GSW Juan C Duchesne MD, FACS, FCCP, FCCM Associate Professor of Surgery Medical Director Tulane Surgical Intensive Care Unit Section of Trauma/Critical Care Surgery/Anesthesia/Emergency Medicine Spirit of Charity Hospital, New Orleans Louisiana

  2. Inverse ratio 42:58 (Blunt: Penetrating) 4.9% severely injured with need of >10 u PRBC/24 hours (Average Nation 1-2%) (War 5-7%)

  3. Bullseye!! Transmediastinal GSW

  4. Bullseye!! Transmediastinal GSW • In North America, the first written thoracic operative record appeared in the diary of Cabeza de Vaca in 1635. • This account described the operative removal of an arrowhead from the chest wall of an Indian.

  5. MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS

  6. Bullseye!! Transmediastinal GSW • The majority of thoracic injuries can be managed non-operatively with tube thoracostomy. • Only 15% to 30% of the penetrating chest trauma require open thoracostomy. • Insertion of a tube thoracostomy is sufficient in treating 70% to 80% of trauma victims.

  7. BULLSEYE!!!!

  8. STOP AND THINK!

  9. Bullseye!! Transmediastinal GSW Hemodynamically Stable YES NO Operating Room, or ED Thoracotomy DEVELOP a GAME PLAN! STUDY injury ANATOMY F.A.S.T. CT SCAN Angiogram Yeeeh ED Thoracotomy! ATTACK! TARGET SPECFIC

  10. Bullseye!! Transmediastinal GSW

  11. EFFECTIVE RESUSCITATION Permissive Hypotension

  12. LVR PRBC FFP Cryo Platelets

  13. Bullseye!! Transmediastinal GSW “DUCHESNE Algorithm” for Hemodynamically Unstable Transmediastinal GSW • Sterile techniques becomes a LUXURY! • ATLS • EFFECTIVE “LOW VOLUME RESUSCITATION!” • “Double Exhaust” Chest tubes • F.A.S.T • Thoracotomy on chest tube side with most Bleeding • Clamshell

  14. Bullseye!! Transmediastinal GSW

  15. Bullseye!! Transmediastinal GSW

  16. Bullseye!! Transmediastinal GSW Hemodynamically Stable

  17. Bullseye!! Transmediastinal GSW

  18. Bullseye!! Transmediastinal GSW

  19. Bullseye!! Transmediastinal GSW

  20. Bullseye!! Transmediastinal GSW

  21. Bullseye!! Transmediastinal GSW

  22. Bullseye!! Transmediastinal GSW Hemodynamically Stable YES NO Operating Room, or ED Thoracotomy DEVELOP a GAME PLAN! STUDY injury ANATOMY F.A.S.T. CT SCAN Angiogram Yeeeh ED Thoracotomy! ATTACK! TARGET SPECFIC

  23. Thanks!

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