2D or 3D TEEin penetrating cardiac injury

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Rob,
 
don't be dramatic. You would watch the patient for clinical signs of tamponade : dilated jugular veins, tachycardia and hypotension. Don't tell me these signs mean nothing to you.
 
If you're talking about needle pericardiocentesis, then perhaps.
I haven't seen it done for ages, I wonder if cardiologists still do it anywhere (not here) ?Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020



> From: rfsmithmd at comcast.net> To: trauma-list at trauma.org> Date: Thu, 6 Sep 2007 17:26:31 -0400> Subject: RE: 2D or 3D TEEin penetrating cardiac injury> > No, I do want a window to assess the nature of the fluid. No blood, or> persistently lavages perfectly clear. Fine, I'm good to go. Blood that> doesn't clear, I want my injury repaired. We take penetrating injuries to> the box fairly seriously because what are you going to watch for? Arrest? As> you point out, the curve on the pressure volume relationship beneath a young> taut pericardium is pretty steep.> > Rob > > -----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 5:15 PM> To: Trauma & Critical Care mailing list> Subject: RE: 2D or 3D TEEin penetrating cardiac injury> > Rob,> > don't tell me you want a thoracotomy with a pericardial window for a> physiological pericardial effusion,> I just don't believe that.> > I think this is the hard part where the surgeon has to be gentle..and do a> little of medical management..> > And also: the presence of a small amount of pericardial effusion without any> other clinical signs of > tamponade I do not think is an indication for a thoracotomy.Ivan Hronek> MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical> Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310> 636-6020> > > > > From: rfsmithmd at comcast.net> To: trauma-list at trauma.org> Date: Thu, 6 Sep> 2007 17:04:02 -0400> Subject: RE: 2D or 3D TEEin penetrating cardiac injury>> > Well if a big shard of glass or piece of metal somehow managed to pierce> my> chest in the area of the box, I'd feel great about being worked up and>> getting a window at least. We wouldn't echo unless penetrating injury. And>> I'm not tough (total wimp), weathered (just aging), or a surgeon (you don't>> even want to know), lol.> > 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 4:54 PM> To:> Trauma & Critical Care mailing list> Subject: RE: 2D or 3D TEEin> penetrating cardiac injury> > ok, you guys are tough weathered surgeons I> understand...> However...a small amount of pericardial effusin is present in> a ceertain> percentage of normal people, perhaps you have some.> How are you> going to feel if you have a small (or medium-sized)> fender-bender and your> trauma surgeons opens your chest and pericardium for> your physiological> pericardial effusion ?Ivan Hronek MD Chief, Critical Care> & Trauma> AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial>> HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020> > > > >> From: rfsmithmd at comcast.net> To: trauma-list at trauma.org> Date: Thu, 6 Sep>> 2007 16:44:36 -0400> Subject: RE: 2D or 3D TEEin penetrating cardiac> injury>> > 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 & 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 :> 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/> > --> 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/> > --> 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/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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