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Wed May 2 17:47:48 BST 2007

Dr. Mattox,

I guess I meant in this EXACT scenario. Of course we all agreed the patient
needs immediate surgical exposure and to have the heart delivered out of the
pericardium. While that effort is being initiated, and since IVs are already
in place, why not give a fluid bolus. I thought this was first line Rx of
tamponade, especially since the pt. appears ready to arrest. Not to DELAY IN
ANY WAY the needed life saving surgical intervention.

Is there harm in providing more filling pressure at the same time the
providers are getting set to open the chest?

R. Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Wednesday, May 02, 2007 10:49 AM
To: trauma-list at trauma.org
Subject: Re: s/w to box

In a message dated 5/2/2007 5:47:26 A.M. Central Daylight Time,  
rfsmithmd at comcast.net writes:

Dr.  Mattox, why do you say no to fluid bolus in this particular  scenario?
Single stab wound to heart; pt. crashing with presumed  tamponade.

R. Smith

What this patient needs is an incision in the chest, either up and down or  
left anterolateral.   If the surgeon desires and is more comfortable  for 
exposure, then a clamshell is appropriate.    Pushing blood  and fluid are
time 
wasting temporarizing efforts only and have their own  complications.    In
my 
view, I see NO indication ever to give  crystalloid fluid boluses in the
trauma 
patient.   That is an old  urban legend, and one that carries its own set of

unfavorable  complications.    Blood and plasma boluses are a different
thing,  
but it takes a while to get such products, and in the patient described,
that 
 time is too long.   CUT.  

k

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