If possible, should have concurrent right sided chest tube being placed
Cut through skin, soft tissue, and muscle in one pass
May scissors can be used to cut the intercostal muscle
Pick up pericardium just anterior to phrenic nerve
Incise from apex to root of aorta parallel to phrenic nerve
Digital occlusion
Skin stapler - if coronary artery stapled, it can be removed in the OR
Foley catheter with purse-string suture around it (closes wound when foley removed)
Horizontal mattress (can be difficult with beating heart)
one-handed vs two-handed
Intracardiac epinephrine
Lower voltages than external defibrillation
Start at 5J to a max of 50J
Up to 30 min is tolerated
Indicated after persistent hypotension after pericardiotomy and fluid resus
Aorta posterior to NGT
Thoracotomy
Needle thoracostomy
Finger thoracostomy
Thoracic lavage
Pulmonary antibiotics
Chest tube
Chest tube 
Thoracentesis