0071643192.pdf

■ Infection

■ Injury or disease transmission to healthcare workers.

INTERPRETATION OFRESULTS

■ SBP after the first 30 minutes of resuscitation predicts outcome. Patients

with SBP >110 mm Hg within 30 minutes have good survival rates and

neurologic outcomes. Those with SBP >85 mm Hg will likely have brain

damage, and those with SBP <70 mm Hg will likely not survive.

A woman with a family history of sudden cardiac death presents following

a syncopal episode. ECG shows intermittent polymorphic ventricular

tachycardia and a QT interval of 600 milliseconds. What is the rhythm dis-

turbance? Which treatments are indicated?

Torsades de pointes. Treat with intravenous magnesium. Consider overdrive

pacing at 140 bpm.

Transcutaneous Cardiac Pacing

INDICATIONS

■ Treatment of hemodynamically unstable bradydysrhythmias that have not

responded to atropine

■ Initial stabilization of the patient in the ED while arranging for transvenous

pacemaker

PROCEDURES AND SKILLS

Phrenic n.Phrenic n.

FIGURE 19.3. (A) Site of incision for thoracotomy. (B) Clamping of descending thoracic

aorta and site of pericardial window. (C) Visualization of the heart for repairs.

(Reproduced, with permission, from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s

Principles of Surgery, 8th ed. New York: McGraw-Hill, 2005:134.)

The ideal candidate for ED

thoracotomy is a victim of a

stab wound to the anterior

chest or abdomen who arrests

after arriving in the ED due to

cardiac tamponade. Get into

the chest and relieve the

tamponade. If the patient

regains a pulse, sedate the

patient—this hurts!