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.
I LOVE this kind of stuff. If I weren’t so darn aged, I would go to medical school in the blink of an eye! Thanks for sharing this.
Thanks for your comment. It’s a rare individual that is fascinated by this kind of thing. I often find myself pining for my medical school/surgery residency days. I’d love to go back and experience all that again.
My background is in laboratory science, which I truly do love, but trauma and surgery are the attention grabbers for me. I absolutely cannot look away, nor do I want to. I loved The Organ Takers, by the way, and anxiously await The Organ Growers.
Thanks Theresa. The Organ Growers is in the hands of the editors, so I’m hoping for a publication date in the next three months. There is plenty of surgical gore in “Growers” as well. I hope you read it.
I like the RN wanting to place a foley, then hang blood.LOL. The GSW could have been a candidate for a clamshell, or not. Your call. I think the national average for post ER thoracotomy survival rate is >10% including those who make it to surgery. doi:10.1016/j.athoracsur.2011.04.042 Trauma: Life In The ER. It’s a young Dr’s/Rn’s/Tech’s job. The burn-out is staggering, and the shortage of skilled, qualified practitioners is only going to get worse I’m afraid. Good videos.
Hi Terence. Thanks for the comment. As you know, survival rate depends on many factors like blunt versus penetrating trauma, whether patients hit the door with or without vital signs or signs of life, stab versus gunshot wounds. In general, we would not crack patients with blunt trauma unless they arrested in the ER, and even then we were very selective. For penetrating wounds that presented with no vitals but still had signs of life (mainly reactive pupils) we would crack them. My few successes with ER thoracotomy were primarily stab wounds to the right ventricle with pericardial tamponade. Release the tamponade, suture the stab wound in the ER, irrigate and close in the OR, send them home to come back another day (trauma is a recurrent disease). Thanks again for the comment. If you’ve read my books I hope you liked them. If you haven’t I hope you do. Richard.
I am a dermatologist so don’t do anything this dramatic in my working life but did witness an ER thoracotomy in medical school in the 80’s. A nurse had been stabbed in the chest coming into work. It was the single most harrowing experience of my training and one which was seared into my memory. He unfortunately did not live and was pronounced in the ER..I love surgery but am completely put off by most surgeons. I am enjoying The Organ Takers.
Hi Clytie. Thanks for taking the time to comment. My multiple experiences performing ER thoracotomies are decades removed, but when I watch the videos posted in my blog post I still have a strong visceral reaction. Your choice of the word harrowing is a good one. Regarding surgeons, we are a difficult group to understand and get along with, and that’s why I think surgeons, surgical diseases, and the OR make for good fiction. I hope the likeable and unlikeable characteristics of my fictional surgeons ring true. The surgeons in my stories are all based on real people and real experiences. I have needed to fabricate very little. I’m glad to hear you are enjoying The Organ Takers. I hope you read the two follow-up books. Thanks again, Richard Anderson.
I just never realized how difficult it was to get to the heart. Very riveting.
Thanks for your comment. This is by far the most popular post on my site.