Emergency Resuscitation Procedures in Major Trauma: Operative Techniques

  • Paolo Aseni
  • Sharon Henry
  • Thomas Scalea


This chapter will describe the common procedures done during the resuscitation of a badly injured patient. We will strive to provide a practical approach to those who deal with injured patients in the hope that this will aid those practitioners and ultimately the patients. Emergency care also entails some immediate lifesaving operations, usually within 1 h with simultaneous resuscitation. During emergency procedures, complications can be minimized if meticulous techniques are adopted. Pleural decompression is a common procedure following major injury and can be a lifesaving procedure; although it is relatively simple, complications can occur if attention to detail is not used. Pericardial window and transdiaphragmatic pericardial window at the time of laparotomy are diagnostic and potential temporarily therapeutic procedures in patients who may have hemopericardium. A median sternotomy is the ideal incision to access the heart and the anterior mediastinal great vessels. The most rapid method of accessing the chest is via an anterolateral thoracotomy: this incision can be performed rapidly and is versatile, as it can be brought across the sternum into a clamshell thoracotomy. Obtaining hemostasis in patients who are bleeding in the pelvis following major pelvic fractures can be challenging: pelvic packing can be lifesaving. Aortic occlusion can be obtained with REBOA which can provide temporary control of hemorrhage almost anywhere in the body.


  1. 1.
    American College of Surgeons Committee. Advanced trauma life support instructor manual. 6th ed. Chicago: American College of Surgeons; 1997.Google Scholar
  2. 2.
    Scalea TM, editor. The shock trauma manual of operative techniques. New York: Springer; 2015. Scholar
  3. 3.
    Fingerhut A, Leppäniemi A, Coimbra R, Peitzman AB, Scalea TM, Voigli EJ, editors. Emergency surgery course (ESC®) manual. New York: Springer; 2016.Google Scholar
  4. 4.
    Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C. Complications of emergency intubation with and without paralysis. Am J Emerg Med. 1999;17:141–3.CrossRefGoogle Scholar
  5. 5.
    Jain U, McCunn M, Smith CE, Pittet JF. Management of the traumatized airway. Anesthesiology. 2016;124:199–206.CrossRefGoogle Scholar
  6. 6.
    Scrase I, Woollard M. Needle vs surgical cricothyroidotomy: a short cut to effective ventilation. Anaesthesia. 2006;61:962–74.CrossRefGoogle Scholar
  7. 7.
    Hsiao J, Pacheco-Fowler V. Videos in clinical medicine. Cricothyroidotomy. N Engl J Med. 2008;358(22):e25.CrossRefGoogle Scholar
  8. 8.
    Park H, Kent J, Joshi M, Zhu S, Bochicchio GV, Henry S, Scalea T. Percutaneous versus open tracheostomy: comparison of procedures and surgical site infections. Surg Infect. 2013;14:21–3.Google Scholar
  9. 9.
    Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40:2890–6.CrossRefGoogle Scholar
  10. 10.
    Cools-Lartigue J, Aboalsaud A, Gill H, Ferri L. Evolution of percutaneous dilatational tracheostomy—a review of current techniques and their pitfalls. World J Surg. 2013;37:1633–46.CrossRefGoogle Scholar
  11. 11.
    Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008;39:9–20.CrossRefGoogle Scholar
  12. 12.
    Meredith JW, Hoth JJ. Thoracic trauma: when and how to intervene. Surg Clin North Am. 2007;87(1):95–118. vii.CrossRefGoogle Scholar
  13. 13.
    Stranch EW, Zarzaur BL, Savage SA. Thinking outside the box: re-evaluating the approach to penetrating cardiac injuries. Eur J Trauma Emerg Surg. 2016. [Epub ahead of print].Google Scholar
  14. 14.
    Mayer HJ. Transdiaphragmatic pericardial window: a new approach. J Cardiovasc Surg. 1993;34(2):173–5.Google Scholar
  15. 15.
    Marshall M. Thoracic incisions. In: Kaiser LR, Kron IL, Spray TL, editors. Mastery of cardiothoracic surgery. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. p. 28–33.Google Scholar
  16. 16.
    O’Connor JV, DuBose JJ, Scalea TM. Damage-control thoracic surgery: management and outcomes. J Trauma Acute Care Surg. 2014;77(5):660–5.CrossRefGoogle Scholar
  17. 17.
    Onat S, Ulku R, Avci A, Ates G, Ozcelik C. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury. 2011;42:900–4.CrossRefGoogle Scholar
  18. 18.
    Seamon MJ, Haut ER, et al. Emergency department thoracotomy. J Trauma. 2015;79:159–73.CrossRefGoogle Scholar
  19. 19.
    Simms ER, Flaris AN, Franchino X, Thomas MS, Caillot J-L, Voiglio EJ. Bilateral anterior thoracotomy (clamshell incision) is the ideal emergency thoracotomy incision: an anatomic study. World J Surg. 2013;37:1277–85.CrossRefGoogle Scholar
  20. 20.
    Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma-a review. Injury. 2006;37:1–19. Epub 2005 Apr 20.CrossRefGoogle Scholar
  21. 21.
    Filiberto DM, Fox AD. Preperitoneal pelvic packing: technique and outcomes. Int J Surg. 2016;33(Pt B):222–4.CrossRefGoogle Scholar
  22. 22.
    Qasim Z, Brenner M, Menaker J, Scalea T. Resuscitative endovascular balloon occlusion of the aorta. Resuscitation. 2015;96:275–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Paolo Aseni
    • 1
  • Sharon Henry
    • 2
  • Thomas Scalea
    • 2
  1. 1.Dipartimento di Emergenza Urgenza ASST Grande Ospedale Metropolitano NiguardaMilanItaly
  2. 2.R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreUSA

Personalised recommendations