Andrew Mittelman, M.D.; Zaid Altawil, M. D.
Faculty Editor: Willie Baker, M.D.
The trauma room is a whirlwind of high stakes, quick thinking, and life-impacting decision. No more so is this evident, then in the case of a traumatic cardiac arrest. The ED thoracotomy, while less in play than it used to be back in the day, is indicated in very select populations. Guidelines are split between the coasts, and individual hospitals have their own policies on the ED thoracotomy should occur.
Given the high adrenaline setting in which ED thoracotomies may occur, it can be very easy to mix up indications, and the written word of policies may be very difficult to review at the moment. In this vein, we wanted to cognitively offload our residents and give them a quick visual reminder, or cheat sheet, on when an ED thoracotomy may be indicated. Given the high stakes involved, it is important to remember that both the ED and Trauma attendings have to in agreement once the time comes for the decision to be made.
The cheat sheet is above, but may also be downloaded at the link below. Institutions may vary in their policies, so for our OSH readers we give a friendly reminder that this is based on the 2019 Boston Medical Center policy on ED thoracotomy. The policy itself can also be downloaded below.
Boston City EM 
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