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Wed May 2 13:55:01 BST 2007

The early papers on pericardiocentesis for heart injuries were in an era  
when an ice pick was the preferred weapon.   Ironically, in the South  (United 
States) the ice picks were distributed freely by the Coca Cola Company  to 
promote their developing new drink, "Coke".   Remember that  refrigeration did not 
exist.   Large chunks of ICE were delivered to  "Ice Boxes" of many homes.   
The Coca Cola was bottled and sold  warm.  The ice picks chipped up the big 
chunks of ice and were put into the  warm drink and make it more enjoyable.   

Should rum, bourbon, or other ETOH be added to the coke, the drinker  
sometimes got unruly.   Sometimes the unruly nature happened without  any ETOH, as it 
does today.   

The Ice Pick was a ready weapon to inflict an assault on someone with whom  a 
disagreement resulted in a fight.  Both the abdominal, chest, and cardiac  
wounds were small, and often did not really require surgery.   

Many of the SW to the heart were small (the size of the ice pick) and a  slow 
production of hemopericardium was produced.   Symptoms developed  slowly 
(over days).   The papers of the time reveal that the patients  who presented with 
a bloody pericardial effusion did so days after the  injury.  The chest x-ray 
did reveal a large pericardial effusion with  dilatation of the pericardium.  
  Pericardiocentesis resulted in  a finding on NON CLOTTING BLOOD, in that 
the blood had been  defibrinated.  Pericardiocentesis resulted in a "cure.",   
although it might require a repeat pericardiocentesis.    Cardiac  Tamponade 
syndrome was relatively rare. 

Acute cardiac tamponade from an acute cardiac injury today is produced by a  
GSW, SW, or misadventure from wire/catheter based treatments of the heart and  
ascending aorta.   This blood is CLOTTED, unless the patient has been  on 
Plavix, heparin or Coumadin.   The clot is difficult to remove even  with a 
DeBakey sucker.   It often has to be removed at time of  pericardiotomy manually.   
 If such a patient survives without  surgery,  after several days, that clot 
becomes defibrinated and can be  removed with a needle or pig tail catheter.   
 Acutely, it  cannot.  

k

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