Let’s crack him—three simple words that sent a shock wave through the ER. Three words that invited every surgery resident, internal medicine resident, medical student, respiratory therapist, lab tech, blood gas tech—and even the housekeeping staff—to flood into the room, hoping to witness the most dramatic procedure, the greatest spectacle, in all of medicine.
In this excerpt from The Organ Takers, the trauma surgery chief resident has just issued the command to perform an ER thoracotomy on a patient who has lost all vital signs. But what is an ER thoracotomy, and what does it mean to “crack” a chest? ER stands for emergency room, of course. Thoraco- derives from the Greek word thorax (chest), and –tomy comes from the Greek word tome (incision), so thoracotomy is the surgical term for incising the chest. An ER thoracotomy, therefore, is the opening of a chest in the emergency room. “Cracking” a chest is jargon for performing a thoracotomy in the emergency department in order to gain immediate access to the heart and other vital structures.
What are the circumstances that would prompt the opening of a patient’s chest, and exposure of their heart, in a hospital emergency room? Dire circumstances, to be sure. If you go to part 3 of the Me, Myself and I interview, I’ll share my experiences with this procedure and give you an example of just how dire the circumstances can be. If you want to see an actual ER thoracotomy, watch the videos below, BUT LET ME WARN YOU, these videos are graphic, violent, and may be quite unsettling for many of you. Should you decide to watch them anyway, please leave a comment. I would like to know how you reacted.
The thoracotomy below was performed on a cadaver and nicely demonstrates the procedure I performed as described in the Me, Myself and I interview.