I‘m a Critical Care Paramedic (Not in the US). I haven’t done a clamshell myself but I‘ve assisted doing one in the field (suicidal pedestrian struck by semitruck on the highway at 100kph). A very radical and intimidating procedure. Sadly in my case of no avail, the Patient suffered from cardiac tamponade, pulmonary avulsion and TBI.
Plastics nurse here, found your videos from a rec from RUclips on the the hailey Bieber situation. Fell into the RUclips rabbit hole and happy I did! Love your videos. Super informative for a lifelong lover of learning 👌🏼
Really interesting video! I'm not a trauma surgeon, but I've worked in EMS for about 7 years and have seen this procedure in action a few times in the emergency department. Unfortunately none of these attempts were successful, but it's certainly a high stress moment for everyone involved
So fascinating! The most amazing learning experience I had in nursing school was my Pathophysiology prof (an ICU nurse for 30 years) tell us the story of her younger brother being saved by this. She was 22 working in the icu. Her brother was working in a mall and stepped into a box crusher machine to try and flatten some boxes by taking them apart to make room for more. He yelled something to his coworker and he thought he yelled to turn the machine on. He went through the machine down to his pelvis and was bleeding out. Miraculously there happened to be a conference for surgeons going on in the mall and 2 amazing surgeons performed a thoracotomy which kept him alive. He passed 3 months later in the same icu she was working at but this allowed their family time to hold him and say goodbye. She told this story while teaching us the physiology of what was happening throughout, through many tears. Most amazing teacher I’ve ever had.
Hi Dr Hilsden, my name is Audry Wright. I have survived this surgery actually a full “clamshell”. I was involved in a head on collision in June of 2022. Thank God & surgeons I am still alive and well!
Hi Dr. Hilsden, I was wondering if you would ever considering dissecting an article in your field or that you might be working on yourself. I would love to see into your thoughts when reading popular research in surgery just as you mentioned here with the paper regarding penetrating trauma with pre-hospital arrest. It would also just be very insightful and educational to have a walk through on how a doctor analyzes research when they are studying. Thank you! P.S. I appreciate your videos so much. they are very educational and interesting!
Thank you. So, I will definitely do that in the future. One of my earlier videos is on the crash 3 trial. Take a look. ruclips.net/video/qnHizVkzH2g/видео.html
I found the most interesting part of your lecture the discussion which led to you saying you would generally proceed with a thoracotomy for a blunt force ED arrest, this is not the case in the UK and Aus. In my experience US surgeons are generally more willing to operate, I was amazed for instance at some of the brain tumours which are tackled over there with very minimal possibility for quality life extension. Not to say one way is more or less correct than the other, I do think 'when not to operate' is more highly stressed in commonwealth nations though so it is always good to hear how a US surgeon approaches such matters.
Great point! We are more aggressive over here for sure. Each situation is unique. The WEST trauma algorithm certainly supports thoractomy for some blunt arrests. EAST guidelines not so much.
Sir, firstly thank you for the great video. I had a doubt I was hoping you could clarify. in all of the mentioned indications of the procedure, is there a role of doing a needle pericardiocentesis? If so, under what circumstances would we consider doing an emergency thoracotomy over doing a needle pericardiocentesis?
Hey Dr. Hilsden thank you for the very interesting video on thoracotomies. If you’re still looking for suggestions i would love to see some tips and advice for students rotating through surgery. What to focus on. Where would be a good source to read up on cases (I’ve heard surgical recall was good). Thanks again.
Hello Dr. Hilsden. Thank you for the video! I was curious about how trauma surgeons interact with other surgical specialties. So once you do the clamshell thoracotomy and get the patient back, would you repair the injury to the heart (i.e. a hole in the heart) yourself or would you need to consult cardiothoracic surgery in order to repair an injury of that nature. Thank you again!
Great video! It's interesting that the "craziest" procedure a trauma surgeon performs can also be done by emergency medicine physicians (probably speaks to the fact that crazy != difficult or risky, since the patient is dead anyway). How do you feel about EM physician performed emergency thoracotomies and have there been any studies comparing outcomes to those performed by surgeons?
my sister survived an anurithom not sure I'm using the right word it's like a heart attack but in the Aorta and she described it as very painful and wanted to died cause of it. so what happens to the heart during this type of medical complication?
I agree definitely a level 1 trauma center procedure. Also, poor outcomes, but I would say all of us trauma surgeons definitely consider this procedure is an important tool in the toolbox.
I am a firefighter/paramedic who has treated several GSW/stab wound patients who have benefited from this procedure. Five patients I personally treated have survived this procedure with full neurological recovery. The ages ranged from 7 years old to 68 years old. All had penetrating injuries to the chest/abdomen.
@@RichHilsden Yes it is and I've had three TCA patients attain ROSC after finger thoracostomy in the field for a tension pneumothorax. Two were penetrating trauma patients and one was a blunt trauma patient.
I’m an OR nurse working weekend nights at a facility that has recently become a Trauma II hospital. I’ve helped the the Trauma Surgeon with a thoracotomy in the ED. Unfortunately the patient didn’t make it. Your video has been very helpful in better understanding some of the details that take place. Thanks
This is so useful, thank you! Please do more educational videos for medical students. I would love to see clinical cases, surgical procedures, managements and so on, related to trauma surgery
Ive had an open lateral thorocatomy (i think i said that right) incision underneath my arm between my ribs. Was the most painful think as far as recovery compared to my other surgeries. Permanent fractured ribs
The more I learn about the human body, the more I’m amazed by it! Although I’m not in med school or pursuing medicine, I love learning about how our body works and how people save it. It’s legitimately mind blowing material.
Hey Dr Hilsden. Has being exposed to death and trauma on a near daily basis shifted your philosophy of life, or the way you look at many of the things that we usually stress about in our daily lives? Or do you prefer not to think about such things and instead purely focus on your craft and work ?
I work in healthcare IT, I was a paramedic student 30 years ago but I remember some things and I do understand this means I'm an idiot. I'm only guessing what an aortic cross clamp is, but I do know that the carotid arteries come off top of the aortic arch so maintaining blood flow to the brain might be preserved by distally stopping flow through the aorta. Aside from trauma, maybe a descending aortic aneurism might be a reason to do that? Am I on the right track? I'm always curious about these things, but more importantly can I have a DNR specifically forbid an aortic cross clamp intervention? Am I right to have serious doubts about quality of life outcomes here?
There is a lot to unpack there. So yeah you could put a clamp on the decending thoracic aorta for any bleeding below the diaphragm. A ruptured AAA, could be an indication. In that particular case, a supra-celic aortic clamp is usually used, now we are really getting into the weeds. Yes the outcomes are potentially bad. That being said I just saw a young guy in clinic who had such a procedure and he is doing great. Having an advanced directive to not have an aortic cross clamp is something you could do, but let’s be honest, not at all practical to set up
I’ve had the clamshell done to myself and I’m one of the miracles that made it
Same me too
I‘m a Critical Care Paramedic (Not in the US). I haven’t done a clamshell myself but I‘ve assisted doing one in the field (suicidal pedestrian struck by semitruck on the highway at 100kph).
A very radical and intimidating procedure. Sadly in my case of no avail, the Patient suffered from cardiac tamponade, pulmonary avulsion and TBI.
What a great video, I have seen this only one time in my 31 year career, brought back several memories. Thank you 🙏
Glad you enjoyed it. This is a fairly common procedure for us, but the survival rate is quite bad. Thanks for watching.
Plastics nurse here, found your videos from a rec from RUclips on the the hailey Bieber situation. Fell into the RUclips rabbit hole and happy I did! Love your videos. Super informative for a lifelong lover of learning 👌🏼
I went through clamshell Thorocotamy in 2015 and survived it without any complications. Thank you Lord
Really interesting video! I'm not a trauma surgeon, but I've worked in EMS for about 7 years and have seen this procedure in action a few times in the emergency department. Unfortunately none of these attempts were successful, but it's certainly a high stress moment for everyone involved
So fascinating! The most amazing learning experience I had in nursing school was my Pathophysiology prof (an ICU nurse for 30 years) tell us the story of her younger brother being saved by this. She was 22 working in the icu. Her brother was working in a mall and stepped into a box crusher machine to try and flatten some boxes by taking them apart to make room for more. He yelled something to his coworker and he thought he yelled to turn the machine on. He went through the machine down to his pelvis and was bleeding out. Miraculously there happened to be a conference for surgeons going on in the mall and 2 amazing surgeons performed a thoracotomy which kept him alive. He passed 3 months later in the same icu she was working at but this allowed their family time to hold him and say goodbye. She told this story while teaching us the physiology of what was happening throughout, through many tears. Most amazing teacher I’ve ever had.
Wow, such an amazing story. Even though he died eventually, that opportunity to say goodbye is so valuable
@@RichHilsden absolutely. It made all the difference in the world to their mom.
thanks for sharing
Hi Dr Hilsden, my name is Audry Wright. I have survived this surgery actually a full “clamshell”. I was involved in a head on collision in June of 2022. Thank God & surgeons I am still alive and well!
Keep making these videos Doctor.
Iv had one of these. It worked funny enough thank you nhs.
Hi Dr. Hilsden, I was wondering if you would ever considering dissecting an article in your field or that you might be working on yourself. I would love to see into your thoughts when reading popular research in surgery just as you mentioned here with the paper regarding penetrating trauma with pre-hospital arrest. It would also just be very insightful and educational to have a walk through on how a doctor analyzes research when they are studying. Thank you!
P.S.
I appreciate your videos so much. they are very educational and interesting!
Thank you. So, I will definitely do that in the future. One of my earlier videos is on the crash 3 trial. Take a look.
ruclips.net/video/qnHizVkzH2g/видео.html
I found the most interesting part of your lecture the discussion which led to you saying you would generally proceed with a thoracotomy for a blunt force ED arrest, this is not the case in the UK and Aus. In my experience US surgeons are generally more willing to operate, I was amazed for instance at some of the brain tumours which are tackled over there with very minimal possibility for quality life extension.
Not to say one way is more or less correct than the other, I do think 'when not to operate' is more highly stressed in commonwealth nations though so it is always good to hear how a US surgeon approaches such matters.
Great point! We are more aggressive over here for sure. Each situation is unique. The WEST trauma algorithm certainly supports thoractomy for some blunt arrests. EAST guidelines not so much.
Sir, firstly thank you for the great video. I had a doubt I was hoping you could clarify.
in all of the mentioned indications of the procedure, is there a role of doing a needle pericardiocentesis? If so, under what circumstances would we consider doing an emergency thoracotomy over doing a needle pericardiocentesis?
Thank you for this!!
Hey Dr. Hilsden thank you for the very interesting video on thoracotomies. If you’re still looking for suggestions i would love to see some tips and advice for students rotating through surgery. What to focus on. Where would be a good source to read up on cases (I’ve heard surgical recall was good). Thanks again.
Surgical recall is great. I will definitely do a video for the med students rotating on surgery
Hello Dr. Hilsden. Thank you for the video! I was curious about how trauma surgeons interact with other surgical specialties. So once you do the clamshell thoracotomy and get the patient back, would you repair the injury to the heart (i.e. a hole in the heart) yourself or would you need to consult cardiothoracic surgery in order to repair an injury of that nature. Thank you again!
Great video! It's interesting that the "craziest" procedure a trauma surgeon performs can also be done by emergency medicine physicians (probably speaks to the fact that crazy != difficult or risky, since the patient is dead anyway). How do you feel about EM physician performed emergency thoracotomies and have there been any studies comparing outcomes to those performed by surgeons?
my sister survived an anurithom not sure I'm using the right word it's like a heart attack but in the Aorta and she described it as very painful and wanted to died cause of it. so what happens to the heart during this type of medical complication?
has anyone blood out after just wondering
Resuscitative thoracotomy is a misnomer, if I am cracking your chest in the ED you are likely not going to make it (
I agree definitely a level 1 trauma center procedure. Also, poor outcomes, but I would say all of us trauma surgeons definitely consider this procedure is an important tool in the toolbox.
You should react to so, want to be trauma surgeon from medical school insider youtube channel
That’s a great idea! Expect to see that soon!
I was a surgical tech and cardiothoracic was my favorite surfery to scrub in on. I was exoecting to see a thoracotomy.
I can only show so much on youtube, but thanks for the comment.
I am a firefighter/paramedic who has treated several GSW/stab wound patients who have benefited from this procedure. Five patients I personally treated have survived this procedure with full neurological recovery. The ages ranged from 7 years old to 68 years old. All had penetrating injuries to the chest/abdomen.
So that is amazing. And yes penetrating chest injuries do best
@@RichHilsden Yes it is and I've had three TCA patients attain ROSC after finger thoracostomy in the field for a tension pneumothorax. Two were penetrating trauma patients and one was a blunt trauma patient.
I’m an OR nurse working weekend nights at a facility that has recently become a Trauma II hospital. I’ve helped the the Trauma Surgeon with a thoracotomy in the ED. Unfortunately the patient didn’t make it. Your video has been very helpful in better understanding some of the details that take place. Thanks
Good idea to drill/practice this procedure because it’s rare in most EDs. ER RN since 1985
So helpful! I'm a medical student and kept getting Uworld questions about this!
This is so useful, thank you! Please do more educational videos for medical students. I would love to see clinical cases, surgical procedures, managements and so on, related to trauma surgery
¿In case of a cardiac tamponade, what scenario would cause you to go for an ED thoracotomy instead of a pericardiocentesis?
Ive had an open lateral thorocatomy (i think i said that right) incision underneath my arm between my ribs. Was the most painful think as far as recovery compared to my other surgeries. Permanent fractured ribs
Yeah that sounds about right. It’s a little different when it’s planned than when we do it emergently
The more I learn about the human body, the more I’m amazed by it! Although I’m not in med school or pursuing medicine, I love learning about how our body works and how people save it. It’s legitimately mind blowing material.
it attractive and easy to understand, need more on trauma surgery
Sir I love your video . In future I want to become a troma surgent . Please suggest me some things that can help me to be a better troma surgent
Stick around on this channel, there are quite a few tips that I mention. Really every video has a few pearls
Hey Dr Hilsden. Has being exposed to death and trauma on a near daily basis shifted your philosophy of life, or the way you look at many of the things that we usually stress about in our daily lives? Or do you prefer not to think about such things and instead purely focus on your craft and work ?
Hey this video was really great. I would like to see more videos on difficult procedures with high risks.
Surgery is full of them!
May💛 God💙 Be 💕With 💜You Always 💙Much 💕Love 🧡Blessings💚 Always ✌ 💯 🌈 🎇 🌐 ❤ 💚💛💛💛💙💙💕💕💕💕💕
Excellent instruction. I won’t try this at home.😄
is it harder to do this on a patient that has a heart murmur?
how long does this procedure take?
I work in healthcare IT, I was a paramedic student 30 years ago but I remember some things and I do understand this means I'm an idiot. I'm only guessing what an aortic cross clamp is, but I do know that the carotid arteries come off top of the aortic arch so maintaining blood flow to the brain might be preserved by distally stopping flow through the aorta. Aside from trauma, maybe a descending aortic aneurism might be a reason to do that? Am I on the right track? I'm always curious about these things, but more importantly can I have a DNR specifically forbid an aortic cross clamp intervention? Am I right to have serious doubts about quality of life outcomes here?
There is a lot to unpack there. So yeah you could put a clamp on the decending thoracic aorta for any bleeding below the diaphragm. A ruptured AAA, could be an indication. In that particular case, a supra-celic aortic clamp is usually used, now we are really getting into the weeds. Yes the outcomes are potentially bad. That being said I just saw a young guy in clinic who had such a procedure and he is doing great. Having an advanced directive to not have an aortic cross clamp is something you could do, but let’s be honest, not at all practical to set up
Hi Dr. Hilsden, premed undergrad from UCLA here. Loved the video your channel is awesome! Hope you keep making these videos
Thanks for your comment. I have a number of friend who are trauma surgeons down there.