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Fri Sep 7 13:55:31 BST 2007

Ivan,

If you're that confident of your intuition that's great. For life
threatening injuries we prefer treatment algorithms that have been developed
and tested over many years. Many of our practice guidelines have been
published. Few, if any, have undergone testing with PRCT's.

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 8:35 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: ECHO in potential penetrating cardiac injury YES YES

Rob, that's the art of the nuances, you just have to do the right thing, you
shouldn't have any misdiagnostic adventures and accept failures: you err on
the side of safety for the patient as always.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

> From: rfsmithmd at comcast.net> To: trauma-list at trauma.org> Date: Fri, 7 Sep
2007 08:28:29 -0400> Subject: RE: ECHO in potential penetrating cardiac
injury YES YES> > 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