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Wed May 9 10:00:01 BST 2007

Dr Mattox - a fascinating history lesson.  I never knew, and it puts the
whole hemopericardium study debate into new light.  Locally, the good
doctors Navsaria et al are investigating the very subject once again, and
we eagerly await the results.

On 03/05/07, Sanjay Gupta MD <sanjaygupta99_91 at yahoo.com> wrote:
>
> Ice picks are still used in India for the same thing -
> break big ice slabs into small pieces and pack around
> coke etc.  Infact, there is a modification which is
> commonly used - imagine a straight needle about 100
> times bigger with a wooden handle at one end.  I once,
> as an intern, saw a patient who had been stabbed with
> this thing in the neck, just above the sternal notch
> and just to the left of the midline.  One could feel
> the tip of the weapon just under the skin of the neck
> posteriorly.  The patient was (obviously) completely
> stable.  He was taken to the OR and a combined neck
> and sternotomy incision were made - no internal
> injuries!!!!
>
>
> Sanjay Gupta
>
>
> --- KMATTOX at aol.com wrote:
>
> > 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
> >
> >
> >
> > ************************************** See what's
> > free at http://www.aol.com.
> > --
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> >
>
>
> Sanjay Gupta MD
> Tel: 412 335 6304
>
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-- 
_____________________
Ross Hofmeyr
MBChB (Stell) ATLS ACLS
wildmedic at gmail.com
ross at wildmedix.com
www.wildmedix.com

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