1. PAOLO FONTANA EMERGENCY LIFE – SAVING THORACIC OPERATIONS CHIRURGIA TORACICA VENEZIA – MESTRE Direttore V. Pagan

2. Reversal of physiologic exhaustion by haemostasis and contamination control, to allow SUBSEQUENT definitive surgery Thoracic DC in muribunds may require temporising CHEST/ABDOMEN lesions manageable by delayed operation AND performing immediate FASTEST and SIMPLEST definitive repair of intrathoracic lethal injuries DAMAGE CONTROL (DC) Thoracic Surgery Venice - Mestre

3. DC IN UNSTABLE PATIENTS SECURE AIRWAY / VEIN EMPIRIC TRANSFUSION DIAGNOSTIC CHEST TUBE US + CXR no delay PERICARDIAL EVACUATION EMERGENCY THORACOTOMY Thoracic Surgery Venice - Mestre

4. ET PRIORITIES Thoracic Surgery Venice - Mestre CARDIAC MASSAGE TAMPONADE RELEASE AORTIC CROSS - CLAMP HAEMORRHAGE CONTROL DIGITAL / FOLEY / CLAMP DIGITAL / FOLEY / CLAMP VASCULAR SHUNT / LIGATION VASCULAR SHUNT / LIGATION SUTURE, STAPLE HEART SUTURE, STAPLE HEART PROPER TRACH TUBE PLACEMENT R. ATRIUM / AORTA TUBING HILAR CLAMP / TWISTING PULM GREAT VESSELS / BRONCHIAL CONTROL PULM GREAT VESSELS / BRONCHIAL CONTROL AIR EMBOLISM AIR EMBOLISM

5. OTHER ET MANEUVERS Thoracic Surgery Venice - Mestre STERNAL/CONTROLATERAL CHEST/CERVICAL/ABDOMEN INCISIONAL EXTENSION LUNG STAPLING, TRACTOTOMY, RESECTION (STAPLED) FAST VASCULAR, DIAPHRAGM, TRACHEA REPAIR N-G SUCTION ESOPH TEAR + MEDIASTINAL TUBES CHEST PACKING (LOOSE CLOSURE)

6. THORACIC COMPARTMENT SYNDROME (+/- ABDOMINAL) CHEST TUBE STOP: ECHO! BLEEDING: MISSED SOURCE? COAGULOPATY? RE-EXPLORATION? (“6 IN 6” RULE) REPERFUSION SYNDROME POST AORTIC CLAMP RELEASE RISK FOR THE SURGEON ET COMPLICATIONS Thoracic Surgery Venice - Mestre

7. ET INDICATIONS UNRESPONSIVE HYPOTENSION DUE TO INFRATOHORACIC HAEMORRHAGE AIR EMBOLISM OR TAMPONADE OR CARDIAC HERNIA EVIDENCE C-P ARREST POST PENETRATING INJURY (S of L EVIDENT BEFORE ARRIVAL) POOR PROGNOSIS FOR BLUNT INJURY AND NO S of L Thoracic Surgery Venice - Mestre

8. LIFE SIGNS CLASS I: NO SIGNS CLASS II: ECG ACTIVITY +/- PULSE OR BP CLASS III: BP<60 mmHg AND TRANSIENT OR NO RESPONSE TO FLUIDS Thoracic Surgery Venice - Mestre

9. ET SURVIVAL 4620 PTS CLASS I + II PENETRATING: 11-30% BLUNT: 1-3% Am. Coll Surg. 2000 Thoracic Surgery Venice - Mestre

10. 1976 – 2009 1871pts ET/THORACOTOMIES 46/253 CLASS II BLUNT ET 33 overall SURVIVAL 5 / 33 ABD +/- THOR INJ 1/15 (6%) THOR INJ ONLY 4/18 (22%) Thoracic Surgery Venice - Mestre (15%)

11. ET PROGNOSTICATORS NO CLEAR SINGLE INDEPENDENT PROGNOSTIC FACTOR S of L IN THE FIELD AND ET WITHIN 15min FROM CLASS II OCCURRENCE IN ALL SURVIVORS Thoracic Surgery Venice - Mestre

12. Thanks to: V. Pagan A. Zaccaria F. Lo Giudice A. Ferronato M. Tisba F. Messina