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Home > List Archives

Penetrating Chest Trauma & CPB

Karim Brohi trauma-list@trauma.org
Mon, 28 Apr 2003 23:42:46 +0100


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Ken,

We had a chap last week stabbed in the left chest through and through left
ventricle and through proximal LAD.  Arrested in ED.  Resuscitative
thoracotomy and to OR (not me).  Ventrcular wound sutured.  Our
perfusionists are off site and 30minute delay before bypass initiated.
Internal massage for this time due to v poor LV function given LAD injury.
Bypassed LAD and to ICU.  Did well on minimal inotropic support but arrested
approx 18 hours later -> died.

Have you ever put a shunt in a coronary artery?

Karim
  -----Original Message-----
  From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]On
Behalf Of KMATTOX@aol.com
  Sent: 28 April 2003 20:25
  To: trauma-list@trauma.org
  Subject: Penetrating Chest Trauma & CPB


  Let us get this very straight.   The need for a PUMP in penetrating chest
trauma is so very rare as to be almost reportable.   In earlier years we
attempted to use the pump for may chest trauma problems.   Thinking back on
it, I know of only ONE case in my career, beginning in 1960 that benefited
from CPB.   It was a case of a SW to the chest with proximal LAD transection
upon whom we performed an immediate CAB after we put the patient on a
portable battery operated CPB in the EC and transported him to the OR.


  I think I have probably managed as many penetrating injuries to the chest
as anyone on this list server.   There is NO logic to have a contengency
plan for an almost never occuring event, especially if that contengency is a
pump and that pump is more than 60 minutes from being available to be hooked
up to the  patient.

  k

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<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff=20
size=3D2>Ken,</FONT></SPAN></DIV>
<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff=20
size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff size=3D2>We =
had a chap=20
last week stabbed in the left chest through and through left ventricle =
and=20
through proximal LAD.&nbsp; Arrested in ED.&nbsp; Resuscitative =
thoracotomy and=20
to OR (not me).&nbsp; Ventrcular wound sutured.&nbsp; Our perfusionists =
are off=20
site and 30minute delay before bypass initiated.&nbsp; Internal massage =
for this=20
time due to v poor LV function given LAD injury.&nbsp; Bypassed LAD and =
to=20
ICU.&nbsp; Did well on minimal inotropic support but arrested approx 18 =
hours=20
later -&gt; died.&nbsp; </FONT></SPAN></DIV>
<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff=20
size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff =
size=3D2>Have you ever put=20
a shunt in a coronary artery?&nbsp; </FONT></SPAN></DIV>
<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff=20
size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D454485921-28042003><FONT color=3D#0000ff=20
size=3D2>Karim</FONT></SPAN></DIV>
<BLOCKQUOTE>
  <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
  size=3D2>-----Original Message-----<BR><B>From:</B> =
trauma-list-admin@trauma.org=20
  [mailto:trauma-list-admin@trauma.org]<B>On Behalf Of=20
  </B>KMATTOX@aol.com<BR><B>Sent:</B> 28 April 2003 20:25<BR><B>To:</B>=20
  trauma-list@trauma.org<BR><B>Subject:</B> Penetrating Chest Trauma =
&amp;=20
  CPB<BR><BR></FONT></DIV><FONT face=3Darial,helvetica><FONT lang=3D0 =
face=3DArial=20
  size=3D2 FAMILY=3D"SANSSERIF">Let us get this very =
straight.&nbsp;&nbsp; The need=20
  for a PUMP in penetrating chest trauma is so very rare as to be almost =

  reportable.&nbsp;&nbsp; In earlier years we attempted to use the pump =
for may=20
  chest trauma problems.&nbsp;&nbsp; Thinking back on it, I know of only =
ONE=20
  case in my career, beginning in 1960 that benefited from =
CPB.&nbsp;&nbsp; It=20
  was a case of a SW to the chest with proximal LAD transection upon =
whom we=20
  performed an immediate CAB after we put the patient on a portable =
battery=20
  operated CPB in the EC and transported him to the OR.&nbsp;&nbsp;=20
  <BR><BR><BR>I think I have probably managed as many penetrating =
injuries to=20
  the chest as anyone on this list server.&nbsp;&nbsp; There is NO logic =
to have=20
  a contengency plan for an almost never occuring event, especially if =
that=20
  contengency is a pump and that pump is more than 60 minutes from being =

  available to be hooked up to the&nbsp; patient.&nbsp;&nbsp; =
<BR><BR>k</FONT>=20
  </FONT></BLOCKQUOTE></BODY></HTML>

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