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Fri Sep 7 02:53:20 BST 2007

OK fine. I'll admit him somewhere and call you frantically when he arrests.
Obviously he is not in tamponade now. Are you saying that his vital signs
make you confident that he doesn't have a cardiac injury that may later in
the night evolve into tamponade?

And talk about VOMIT, why do a test you have no intention of acting on?

Rob

-----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 9:47 PM
To: trauma-list at trauma.org
Subject: Re: 2D or 3D TEEin penetrating cardiac injury No NO 

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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2D or 3D TEEin penetrating cardiac injury No NO