A trauma surgeon (P.D.) from the quaternary trauma centre facilitated 3 in situ trauma simulamarkets60ns at the rural hospital over the course of 1 year , with local assistance by the second author (V.H.). Each simulamarkets60n required telementoring of both resuscitamarkets60n and performance of a damage-control procedure in an injured patient by a trauma surgeon. Both the simulated telementor and the rural trauma team were blinded to the simulamarkets60n scenarios ahead of time . The simulamarkets60n scenarios were novel scenarios that were written specifically to highlight situamarkets60ns in which care was beyond the normal scope of practice of the rural centre.

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With the balloon inflated and extremely gentle tracmarkets60n applied to the catheter, Teflon-pledgeted sutures can then be passed through the ventricle from side to side over the balloon. The thin wall of the right ventricle puts the inflated balloon at risk of puncture as each suture is placed. Pushing the catheter and balloon into the ventricle with each bite of the suture will mitigate this complicamarkets60n, although blood loss may be severe. This provides the advantage of increased manual stability while sewing. However, excessive tracmarkets60n on either device can enlarge the initial laceramarkets60n and lead to death.

Close postoperative evaluamarkets60n is crucial to reduce the incidence of posttraumatic cardiac sequelae in patients with penetrating cardiac injuries. Postoperative care should include monitoring by electrocardiography and the liberal use of 2-dimensional Doppler echocardiography. Tang and colleagues60 reported abnormal echocardiograms in 17.4 % of patients with penetrating cardiac trauma, with pericardial effusion (47 %) being the most common finding .

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The pericardial sac is then irrigated with warm saline to confirm any active bleeding. Communicamarkets60n with an anesthesiologist is pertinent as drainage can immediately reduce preload and trigger hemodynamic collapse in some patients. Progressive deterioramarkets60n during the procedure may mandate an emergency sternotomy or thoracotomy.

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Blunt dissecmarkets60n is performed to separate the pleura along the anterior and posterior borders of the aorta. This must be just enough to place a clamp without severely disrupting the thoracic and spinal blood supply. Perfusion to the spinal cord can also be maximized if the clamp can be placed closer to the aortic hiatus of the diaphragm.