Thoracotomy with direct cardiac massage in an attempt to resuscitate!
This is a young male who had multiple gunshots in his chest and abdomen.
A decision was made for a bedside resuscitative thoracotomy.
Access to the heart and lungs was obtained and the patient was found to have an injury from the gunshot to the IVC. The aorta was cross-clamped distal to the arch to redistribute the blood to the myocardium and the brain.
The aorta is ideally clamped just above the diaphragm to maximize spinal cord perfusion, but the aorta can also be clamped just below the left pulmonary hilum.
Pericardiotomy was carefully performed avoiding the phrenic nerve to check for any injuries or cardiac tamponade. Cardiac massage was performed as well.