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When a life-saving procedure like resuscitative thoracotomy is required, the resus clinician and the team need to have mentally prepared for this in the past, including being crystal clear on the INDICATIONS and the IMPLICATIONS of the procedural, as well as the technical steps. The decision making is often the hardest part, so do this ahead of time.
This is an excerpt from 'Making Things Happen', a talk given at the first SMACC conference in 2013