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Fri Sep 7 13:28:29 BST 2007

Ivan,

This seems reasonable if you can reliably do it. Our problem has been how to
do this in a really busy trauma unit? Pts. Can get "lost" in the chaos for a
little while. Then it's like you're checking every couple hours or so which
we're not comfortable with. If you admit to the ward, even worse. 

I really don't think I'm knife happy, lol. The trauma surgeons are willing
to accept a certain level of positive but non therapeutic windows and not
miss any true injuries.

Rob

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of IVAN HRONEK
Sent: Friday, September 07, 2007 7:09 AM
To: Trauma &amp; Critical Care mailing list
Subject: ECHO in potential penetrating cardiac injury YES YES

Watch: pulse, skin temperature, CNS status, NIR, nailbed color etc q 30 min.
- if any of them got any worse 4 L IC thoracotomy and a HUGE pericardial
window within 5 minutes.
Or maybe nothing as he has been stable for 48 hrs.
Ivan

> Date: Fri, 7 Sep 2007 10:14:50 +0200> From: Pradeep.Navsaria at uct.ac.za>
To: trauma-list at trauma.org> Subject: RE: 2D or 3D TEEin penetrating cardiac
injury No NO> > I have not been closely following the discussion, however I
present to you the following case seen in our unit this week - :> > Adult
male - referred from district hospital> > Praecordial stab Saturday -
referred Mon.> > Haemodynamically stable - no evidence of tamponade.> > CXR:
right haemothorax - ICD, straight left heart border, mediastinum normal> >
ECG: ST segment elevation - V2-V5> > Ultrasound (radiologist) - 6mm
effusion.> > WHAT WOULD YOU DO IN YOUR CENTER?> > > > CXR> > > > > > > >>>
IVAN HRONEK <ih7 at msn.com> 2007/09/07 07:25 am >>>> That's right - that's
what you do ! I agree.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 07:23:08 +0200> From: tch at sun.ac.za> To:
trauma-list at trauma.org> Subject: RE: 2D or 3D TEEin penetrating cardiac
injury No NO > > Rob> > Basics - CXR; to exclude the need for chest tube
(what were the lung sounds / percussion??)> FAST sonar for heart - would
watch with resonar 6hrly any effusion less than/= to 5mm.> > Nil else -
short stay ward. Regular clinical review.> > 85% of these are home in 24
hours.> > 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 Robert F. Smith> Sent: Friday, September 07, 2007 3:38 AM> To:
'Trauma &amp; Critical Care mailing list'> Subject: RE: 2D or 3D TEEin
penetrating cardiac injury No NO > > > 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?> > 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 9:19 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 8:14:04 P.M. Central Daylight Time, > rfsmithmd at comcast.net
writes:> > 3. With appropriate mechanism, and a positive finding on FAST,
what> clinical> findings are you going to wait to see?> > > > > A patient
with symptoms that matches the positive image seen on the FAST.> > It is
ludicrous to operate on a patient that does not need an operation,> put > a
stent graft in a patient without a vascular lesion, etc. > > VOMIT. Treat
and OPERATE on a patient NOT an image. The image test is > just a something
to aid in diagnosis. > > k > > > > **************************************
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ECHO in potential penetrating cardiac injury YES YES