JC: Predicting Outcomes + Resuscitation

This weeks readings:

Inaba K, Chouliaras K, Zakaluzny S, et al. FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy. Annals of Surgery 2015;262(3):512–8. 

Questions:

  1. "All were penetrating thoracic injuries with a pericardial effusion on FAST and all were emergently brought to the operating room for a planned sternotomy and were ,therefore, excluded from the study." How do you think this affected the primary outcome?
  2. The authors conclude that identification of pericardial fluid can prevent unnecessary thoracotomies, saving resources and potential risks to the practitioners.
  3. What is the actual resource burden and risk to the practitioner
  4. Can you think of any benefits to performing thoracotamies despite the low survival rate of the patient?
  5. How might this apply to the paediatric population?

Adedipe, A. A., Fly, D. L., Schwitz, S. D., Jorgenson, D. B., Duric, H., Sayre, M. R., & Nichol, G. (2015). Resuscitation. Resuscitation, 1–5. http://doi.org/10.1016/j.resuscitation.2015.07.024  

Questions:

  1. Why do you think they chose to record only for 5 mins?
  2. Is there value in checking carotid flow for longer? or for other parts of the CPR cycle?
  3. The authors describe some patient populations where carotid flow might not be feasible.
  4. What limitations might there be in traumatic arrests?
  5. What about the paediatric arrests?
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