This document discusses various surgical procedures that may need to be performed in emergency situations, including surgical airways, open thoracostomies, lateral canthotomies, escharotomies, field amputations, clamshell thoracotomies, and perimortem hysterotomies. It provides tips for performing these procedures and emphasizes having the necessary skills and equipment prepared in case an infrequently performed life-saving procedure is needed. Cognitive preparation is important as some of the procedures are not visually guided. Potential outcomes and complications are also addressed.

1. Disclosures
courtesy http://www.ranulphfiennes.co.uk

2. Always Carry Your Scalpel
Brian Burns

4. Procedures
Are sometimes performed infrequently
by Fiona Reardon
Life saving
YOU MUST PREPARE FOR THESE PROCEDURES
Cognitive hurdle

5. Surgical Airway
courtesy jack milenius

6. Surgical Airway
courtesy jack milenius

7. 6

8. SURGICAL AIRWAY is
NOT a VISUAL procedure

9. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE

10. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE
LOCATE

11. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE
LOCATE
INCISE

12. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE
LOCATE
INCISE
FEEL

13. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE
LOCATE
INCISE
FEEL
BOUGIE

14. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE
LOCATE
INCISE
FEEL
BOUGIE
TUBE

15. SURGICAL AIRWAY is
NOT a VISUAL procedure
DECIDE
LOCATE
INCISE
FEEL
BOUGIE
TUBE
ETCO2

19. Surgical Airway - tips

21. Open thoracostomy

24. courtesy BMJ

27. Sight Saving Procedure

29. Lateral Canthotomy

30. Lateral canthotomy-tips

31. Escharotomy

33. Field Amputation

37. Field Amputation

38. Clamshell thoracotomy
Indications
Contraindications
Clamshell
Thoracotomy

43. Possible Outcomes….

44. courtesy London HEMS

45. Clamshell thoracotomy-TIPS
courtesy London HEMS

46. Things to avoid….

48. Perimortem hysterotomy
Cardiac arrest > 24 weeks gestation
<5 minutes to deliver baby from cardiac arrests
Takes 1 minute, hence start at 4 minutes after arrest

49. Perimortem hysterotomy
Cardiac arrest > 24 weeks gestation
<5 minutes to deliver baby from cardiac arrests
Takes 1 minute, hence start at 4 minutes after arrest
dogma ?

50. Perimortem hysterotomy
Scalpel & Scissors

51. Perimortem hysterotomytips
Umbilicus =20 w. 1 week/cm above that
Don’t stop chest compressions
Cut around the umbilicus

52. Things not cool with a
scalpel
cutting yourself during procedure
cutting the pilot tube of an ETT instead of trachy tape
NOT using it when indicated
forgetting to bring your scalpel

55. Thank you !