Resuscitation legend John Hinds talks about the consequences of our actions in resuscitation. He discusses resuscitative emergency thoracotomies and the philosophy and mindset required by the practitioner rather than the technicalities of how to perform it. As John says, trying to find the fault in a wiring loom of a ZX10 is difficult. Opening a chest is not. But it has been built up to be such a heroic procedure that we're stopping people doing it. John discusses a case and the way it was discussed in the ensuing mortality meeting. He breaks down the personalities you see in these meetings - the sycophants, supporters, the skeptics and coins the phrase #resuswankers. The hardest part of a resuscitative thoracotomy is not making the first cut - it's dealing with the #resuswankers. Using simulation, optimising logistics and training the team effectively John managed to change the culture in an institution. This translated into an incredible save. Take home points include: Prepare. Know the evidence. Make your intentions honourable. Do it. Seek out the skeptics. Never allow a wanker to bring you down. He does this with his usual dry wit, genuine passion and refreshing modesty that have made him so popular. To see how mating hippos and batman are of relevance, you'll have to watch the talk. John will be dearly missed by our community and this talk shows you why.

1. Crack the Chest; Get Crucified.
Hinds

2. What if you actually DO one…?

5. Terminology
• Urgent Thoracotomy
• Emergency Department Thoracotomy
• Emergency Thoracotomy

6. Terminology
• Urgent Thoracotomy
• Emergency Department Thoracotomy
• Emergency Thoracotomy
RESUSCITATIVE THORACOTOMY

7. This talk contains no references.

8. Are my intentions honorable?

15. Patient Zero.

17. Morbidity and Mortality meeting

19. • Sycophants

20. • Sycophants
• Supporters

21. • Sycophants
• Supporters
• Skeptics

22. • Sycophants
• Supporters
• Skeptics
• Wankers.

23. Sycophants

24. Supporters

25. Skeptics

26. Skeptics
• “It’s a dramatic procedure, done by cowboys”
• “It’s futile”
• “These people never survive”
• “It should only be done by Cardiothoracics”

27. Wankers.

29. Wankers.
Understand the evidence and intention,
….but criticize anyway
Or
Too stupid to understand

30. #ResusWankers

31. “The most difficult part of a
Resuscitative Thoracotomy is
the decision to make the cut”

32. “The most difficult part of a
Resuscitative Thoracotomy is
the decision to make the cut”

33. “The most difficult part of a
Resuscitative Thoracotomy is
dealing with #ResusWankers ”

37. “What a total
Resus Wanker”

44. Changing your institutions approach

54. XXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXX

56. Don’t surprise the room

58. Rules at the start
• Don’t commit the patient to a thoracotomy
because of a duff anaesthetic
• If they do arrest, don’t dick about with a duff
resuscitation attempt

66. Why Clamshell?

67. • Faster.
• You can get at more stuff in there.

68. Why Clamshell?
It’s not a proper resuscitative procedure if
you can’t fit your head in it.

71. “These guys never survive”

73. Things to take home

74. Things to take home
• Prepare. Know the evidence.
.

75. Things to take home
• Prepare. Know the evidence.
• Make your intentions honorable
.

76. Things to take home
• Prepare. Know the evidence.
• Make your intentions honorable
• Do it.
.

77. Things to take home
• Prepare. Know the evidence.
• Make your intentions honorable
• Do it.
• Seek out the Skeptics.
.

78. Things to take home
• Prepare. Know the evidence.
• Make your intentions honorable
• Do it.
• Seek out the Skeptics.
• Never allow a Wanker to bring you down.