List Archives

Thu May 3 12:00:06 BST 2007

Seen two tamponades on ER thoracotomy and all the blood was clotted. Makes
one wonder why pericardiocentesis is still taught as a viable option in
trauma.

S Muzammil, FRCS

----- Original Message -----
From: "Pret Bjorn" <p.bjorn at netzero.net>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Wednesday, 02 May, 2007 6:47 AM
Subject: RE: stabbed heart

> Shows what I know.  I hate it when that happens.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
> On Behalf Of kmattox at aol.com
> Sent: Tuesday, May 01, 2007 6:26 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: stabbed heart
>
> Pericardiocentisis is NOT indoicated, nor effectiive.  The bulk of the
> offending blood ois clotted and cannot be removed w a needle.
>
> K
>
>
> Sent via BlackBerry from Cingular Wireless
>
> -----Original Message-----
> From: "Pret Bjorn" <p.bjorn at netzero.net>
> Date: Tue, 1 May 2007 18:57:15
> To:"'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
> Subject: RE: stabbed heart
>
> I see the votes are favoring thoracotomy.  Me, I'd be looking for a
> pericardiocentesis.  THEN intubation, chest tubes, IV access, and by then
> the OR should be ready, if he still needs it.
>
> If there's nothing hidden, draining the pericardium should do a world of
> good, and it only costs you thirty seconds, with none of the inherent
> high-risk melee of opening the chest of a combative patient in the ED.
>
> In a lean kid, it should be an easy stick.
>
> Easy for ME to say.
>
> Pret Bjorn, RN
> Bangor, ME
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
> On Behalf Of caesar ursic
> Sent: Tuesday, May 01, 2007 4:51 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: stabbed heart
>
> True story:
>
> 16 yo previously healthy male stabbed once in anterior chest.  Confused
and
> combative at scene.  Minimal external blood loss noted.  Paramedics scoop
> and run - one antecubital IV, minimal fluid given en route (less than 20
> mL), no attempt at intubation.  Eight minute interval from first patient
> contact at scene to arrival in ED.
>
> On arrival to ED he's even more combative; very diaphoretic, ashen-colored
> lips, cool periphery; carotid pulses not palpable (but he's thrashing
about
> too much to really tell).  Only obvious external injury is a 3-4 cm stab
> wound just to the left of the xyphoid.  Breath sounds are equal.
>
> Patient intubated (rapid sequence orotracheal) within three minutes of
> arrival.  FAST shows fluid around heart, no fluid in abdomen.  He's been
in
> the ED for about four-five minutes.  Now it is clear he has no palpable
> pulses.  Cardiac monitor: sinus tachycardia at 150 bpm.  Nobody can feel a
> pulse in this thin 16 y.o. boy.
>
> The on-call surgeon is in the room and is trained and willing to open
chest,
> put in chest tubes, insert a central line, etc. The OR will be ready to
take
> the patient in 5-10 minutes, but not immediately.
>
> What is the next step?
>
> A. bilateral large bore tube thoracostomies
> B. resuscitative left anterolateral thoracotomy (in the ED)
> C. fluid bolus or o-positive packed RBCs (i.e. volume-expand)
> D. start epinephrine, calcium
> E. subxyphoind pericardiocentesis
> F. none of the above
>
> I am not trying to trick you - there are no other hidden injuries.
>
> Many thanks, etc.
>
> Caesar Ursic, MD
> Santa Fe, USA
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>

List Archives

For your convenience, find the Trauma List Archive Below

stabbed heart