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Thoracic Injury Management
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
David R. King, James V. O’Connor
This incision affords superb exposure to the anterior mediastinum and both pleural spaces, and is ideally suited as the resuscitative thoracotomy of choice. As mentioned earlier, a left anterolateral thoracotomy can be extended as a clamshell. Using a Lebsche knife, sternal saw, and trauma shears or bone cutters, the sternum is divided horizontally. The incision is then extended as a right anterolateral mirror-image thoracotomy (Figure 6.5). There are several key technical details:
Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents
Published in Prehospital Emergency Care, 2019
Robert P. Chilcott, Hannah Mitchell, Hazem Matar
Where applicable, the disrobe and dry decontamination process was performed by 3 decontamination team members (DTMs) as follows (Figure 2):Each volunteer was asked to lie on a stretcher lined with Blue Roll (Wypall, Tork) and to remain flaccid and unresponsive. Decontamination Team Member 1 (DTM1) supported the head and neck, using a strip of Blue Roll placed under the volunteer's head.The front of the volunteer's clothing was cut using trauma shears (Tuff Cut, Reliance Medical, UK) and peeled away (Figure 2A). During this time, DTM1 started to blot the hair with Blue Roll.The DTM to the left of the casualty (DTM2) started blotting accessible areas of the lower limbs, while DTM3 (to the right of the casualty) blotted the accessible areas of the upper body (Figure 2B). Both DTM2 and DTM3 prioritized the areas of skin that had not been clothed (i.e., feet, hands, and face), particularly if liquid contaminant was visible on the skin surface.Following a change of Blue Roll, Team Members progressed from blotting to rubbing the skin surfaces (Figure 2C), after which the volunteer was carefully rolled to their left on to a clean stretcher (which was covered with fresh Blue Roll) and placed into the recovery position. At this and all other times, DTM1 was using the Blue Roll to support the head and neck to prevent direct contact with the hair (Figure 2D).With the volunteer lying in the recovery position (Figure 2E), step 3 was repeated with fresh Blue Roll.The original stretcher was wiped down with the existing Blue Roll (by DTM3) to remove any overt contamination. The contaminated Blue Roll was then replaced with fresh material (Figure 2F).The volunteer was then rolled back on to the original stretcher, with care to support the head and neck (Figure 2G).After being placed supine (Figure 2H), the volunteer was instructed that the decontamination process was completed and was escorted to the photographic booth for a final photograph.Finally, the volunteer was escorted to a sampling room for skin and hair surface swabbing.