Emergent thoracotomy may be indicated, keeping in mind caveats discussed previously.
Thoracotomy in dogs is generally best done through a LEFT lateral thoracic wall approach, generally at the 4th to 5th or 5th to 6th intercostal space to afford optimal visualization. A median approach is not recommended in MWDs, given difficulties in post-operative management.
Euthanasia should be considered for a MWD for which a resuscitative thoracotomy is deemed necessary but cannot be performed or has proven unsuccessful (See CPG 21).