Requested by Dr. Strayer as written by Dr. Porat –

“As EMS was puling up someone came into the trauma bay and yelled “he just lost his pulse.” This gave me time to grab the thoracotomy tray and open it up. These extra 2 minutes gave me time to open the tray, remind myself what I actually need in the mess of OR instruments and grab the scalpel. As soon as the patient was moved onto our bed and we confirmed he had no pulse I started to cut. I remember hearing in one of our recent tutorials it should take 3 cuts to be in the chest so with pressure and force I made the first cut through the skin and fat, next through more fat and finally through muscle. Looking back I probably should have extended my cut more anteriorly. I then grabbed the rib spreaders and wedged them between the ribs and started to crank. The chest cavity opened much more easily then I expected exposing first the lung and then the pericardial sac. It was whiter than I remembered so at first I didnt even recognize it with the heart barely beating. The hardest part of the procedure was cutting the pericardial sac and I was afraid of cutting the heart. Once open the patient once again lost his pulse so I very cautiously placed my hands in the chest cupping the heart. I was very conscious of the broken ribs trying my hardest not to get cut. The heart was much softer and smooshier than the water-filled glove I practiced on and remembering to keep the pace of a normal heart rate and not a respiratory rate (it sort of is the motion of squeezing a BVM) was hard at first. But once I got into a rhythm it was easy. I have to say, it was the first time i did a high adrenaline procedure and didn’t feel shaky or my heart pounding. This allowed me to approach it calmly focusing on every step so as not to put myself in any unnecessary danger and allowed the procedure to run smoothly. “