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Thu Sep 6 21:44:36 BST 2007

Ivan,

I was just skimming your post and noticed the "even small amounts of
fluid... etc." so I figured you would intervene for same. A long long time
ago in a hospital far away, the cardiologist would sometimes say "Echo
positive only for small amount of physiologic fluid." Then one of those
patients fell over while having a bowel movement because he had tamponade.
Since then all penetrating injuries to the "box" gets an echo ANY fluid
requires surgical intervention. This approach has proven beneficial many
times.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of IVAN HRONEK
Sent: Thursday, September 06, 2007 2:49 PM
To: Trauma &amp; Critical Care mailing list
Subject: 2D or 3D TEEin penetrating cardiac injury

Matt,

obviously, you know 2D TEE is best, and now 3D TEE is becoming available.
We recently found a small pericardial effusion in a GSW to L chest - 
I advised to watch the patient as the etiology of the effusion obviously at
that one instance of examination wasn't clear.
As you know acute pericardial tamponade can happen even with small volumes
of effusion as the peridcardium hasn't been "stretched" by a slowly
accumulating effusion.

What are people's experiences with tamponade - I am sure there are millions
of horrendous stories....

Anybody has a better way than just watching the patient  ?
Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.

> Date: Thu, 6 Sep 2007 19:35:45 +0100> From: mgreeds at reeds.uk.com> To:
trauma-list at trauma.org> Subject: ECG in penetrating cardiac injury> >
Sa'ad,> > I once questioned the role of ECGs in demonstrating penentrating
cardiac > injury. Unfortunately, I never got round to conducting a full
review of > the literature but I have cited a few articles below which I >
provisionally found some time ago.> > I am not aware of any significantly
powered and properly conducted > studies to demonstrate the effectiveness of
ECGs (I would nevertheless be > keen to hear from others on the list who
have any enlightening data > either way.) My belief is that it does not have
any real role as there > have been a number of penetrating cardiac injuries
documented which do > not demonstrate any ECG changes and would have been
missed if relied upon > as a single diagnostic test.> > > Absence of
hemodynamic and ECG changes in a patient with traumatic left > ventricular
injury and puncture of the left anterior descending branch. > Südkamp M,
Geissler HJ, de Vivie ER. Thorac Cardiovasc Surg. 2000 Dec;48> (6):373-5.> >
Penetrating cardiac trauma: follow-up study including > electrocardiography,
echocardiography, and functional test. Duque HA, > Florez LE, Moreno A,
Jurado H, Jaramillo CJ, Restrepo MC. World J Surg. > 1999 Dec;23(12):1254-7.
(About post-operative monitoring NOT diagnostics)> > Dysrhythymia from an
intrapericardial air gun pellet: a case report. > Willemsen P, Kuo J, Azzu
A. Eur J Cardiothorac Surg. 1996;10(6):461-2. > (Anecdotal case.)> > > The
literature mostly refers to echocardiography being a much more useful > test
(greater sensitivity and specificity.) Although the last publication > above
refers to ECG changes being better at diagnosing penetrating > cardiac
injury in that particular case than echocardiography.> > I feel that nothing
can compare to appropriate histroy, examination of > the patient, mechanism
of injury (e.g. knife stab wound to anterior chest > = high probability of
cardiac injury until proved otherwised etc.) and > echo/FAST etc. are more
appropriate in making a proper diagnosis.> > > Matthew> > --> trauma-list :
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2D or 3D TEEin penetrating cardiac injury