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Fri Sep 7 02:46:33 BST 2007

In a message dated 9/6/2007 8:39:29 P.M. Central Daylight Time,  
rfsmithmd at comcast.net writes:

Ok so  you have an 18 yr old male presenting with a stab wound over  the
precordium. His pulse is 90, BP 110/70, RR 18. No retained missile.  Would
you do any diagnostic studies and why and what findings would you  take
action on?

Wonderful example.   As presented, there is NO WAY under God's  heaven that 
he could have a pericardial tamponade.   Too wide a pulse  pressure.    I would 
look for a pulsus  paradoxus.    I am perfectly happy with this clinical  
presentation.   I would admit him to a short term unit for overnight  
observation.  I would not object to a FAST, but even if positive I would  not operate on 
this patient who is NORMAL at this time.  

k

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