List Archives

Fri Sep 7 02:38:19 BST 2007

I agree with Rob the test has to agree with the clinical condition of the patient.

However, there are a number of trauma patients that come to the OR for various reasons and in those patients doing a TEE is very simple, as they are intubated. In a asymptomatic patient who is not intubated, a TTE can be done.
Also, TEE helps as another monitor during a serious case of hemorrhagic shock as it dynamically shows the volume status of the patient. It sure helps me a lot. The volume status is often not easy to determine and the reason for hypotension is often not that easy to determine.

The diagnosis of 1. pericardial effusion/hemorrhage or tamponade  and 2. aortic dissection the TEE is still the best imaging technique also available directly in the operating room. The patient can be followed-up with a TTE on the floors or in the ICU.Ivan

> From: rfsmithmd at comcast.net> To: trauma-list at trauma.org> Date: Thu, 6 Sep 2007 21:13:06 -0400> Subject: RE: 2D or 3D TEEin penetrating cardiac injury No NO > > 1. I thought FAST was an ECHO.> > 2. If you're doing the test and not going to act on the positive findings> then why do it? As Ben said.> > 3. With appropriate mechanism, and a positive finding on FAST, what clinical> findings are you going to wait to see?> > Rob 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: Thursday, September 06, 2007 9:03 PM> To: trauma-list at trauma.org> Subject: Re: 2D or 3D TEEin penetrating cardiac injury No NO > > I had intended to watch and learn, but I can no longer remain silent. My> > fear is that the unprepared mind might become confused by this discussion,> or > even might make the evaluation of cardiac injury more difficult. I am > very concerned that the focus is now on technology and not the patient.> EVERY > technology can be helpful and can be a VOMIT. > > 1. WHY in the name of whatever is decent and honorable, why are we trying > to make things more difficult. > > 2 FAST is helpful (if the test is POSITIVE) to suggest hemopericardium, > but NOT diagnosic of any real clinical condition unless the test coorelates> > with the clinical findings. PERIOD. > > 3. ANY ECHO (TTE, TEE, 2D, 3d, ETC. ETC. ) is a RANDOM NUMBER GENERATOR > and creates more problems, including increasing the cost of care, much more> > than it is worth. The risk benefit ratio is just not worth it. TEE is> a > test suggested by someone who needs some way of making a living because> they > have no other skills that this particular patient needs. There are some > narrow indications and benefits for TEE, but this and use of TEE for> potential > aortic injury are just not among those indications > > 4. For trauma, TEE is a massive, MASSIVE VOMIT. Enough said on this > subject. > > k> > > > ************************************** Get a sneak peek of the all-new AOL> at > http://discover.aol.com/memed/aolcom30tour> --> 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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ECHO in peric.tamponade, ao dissection, volume status