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Fri Sep 7 06:13:54 BST 2007

Thanks Tim, 

I agree with what you're saying. However I would not say echo is confounded by pleural fluid - the pleural fluid is very easy to distinguish from pericardial fluid as it is jus not around and close to the heart.
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

> Date: Fri, 7 Sep 2007 07:05:26 +0200> From: tch at sun.ac.za> To: trauma-list at trauma.org> Subject: RE: 2D or 3D TEEin penetrating cardiac injury> > Ben> > You have obviously never had to re-open a sternum on a previous sternotomy patient. I know of too many cases of sternal saw to hear in redo's to not want to open a chest unnecessarily.> > Echo / Sonar has been shown to be overly sensitive. Only react to an effusion of over 5mm (some people even use 8mm) in the stable patient. If unstable - operate, no question. There is extensive evidence from South Africa and the USA that this is safe and indeed prudent. Echo is often confounded by associated pleural fluid too.> > Regards> Tim> Dr T C Hardcastle> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)> ATLS instructor and DSTC Cape Town Course Director> Intern program Coordinator: Surgery> M.Med (Emergency Medicine) Executive Committee member> Clinical Head (Director): Diana Princess of Wales Trauma Unit> Division of Surgery (General) Room 4064> Department of Surgical Sciences> Tygerberg Hospital / University of Stellenbosch> PO Box 19063> Tygerberg 7505> Western Cape> South Africa> e-mail: tch at sun.ac.za> Cell: +27824681615> Office: +27219389281 or 4911 pager 0302> > > > -----Original Message-----> From: trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]On Behalf Of Ben Reynolds> Sent: Thursday, September 06, 2007 10:17 PM> To: ih7 at msn.com> Cc: trauma-list at trauma.org> Subject: RE: 2D or 3D TEEin penetrating cardiac injury> > > I am one of those people who don&#39;t believe in &quot;observation&quot; or &quot;conservative management&quot; of penetrating wounds to the heart. Seeing blood on echo (whether 2D or whatever) in my mind is the same as a positive pericardial window: Exploration becomes mandatory. > > Rare is the instance that one loses sleep over a nontherapeutic exploration.> > Ben Reynolds, PA-C> > IVAN HRONEK wrote: > > 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/

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2D or 3D TEEin penetrating cardiac injury