ED thoracotomy

Indication
penetrating trauma with less than 10 mins CPR
5th ICS sternum to bed down on to rib
cut down to pleura and through small area laterally then use fingers and scissors to extend
chest wall restractor
open pericardium (root of aorta to apex)
repair heart foley catheter or staples
clamp thoracic aorta
clamp lung root (can twist hilum)
rapid transfer to OT