A 30yoM stabbed in the left 4th IC space suddenly arrests as he rolls into the trauma bay. You perform a left sided thoracotomy, open the pericardium, to find a laceration to the left ventricle which you put your index finger over, successfully stopping the bleeding. However the heart appears to beating irregularly and you see VFib on the monitor. What do you do now?

Answer: Place a foley in the defect or staple it (http://emedicine.medscape.com/article/82565-overview#a15) and perform intrathoracic defibrillation (using appropriate paddles) at 20-40J.