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Fri Sep 7 14:26:56 BST 2007

A physiological pericardial fliud is not life threatening - you really like do be dramatic..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 08:55:31 -0400> Subject: RE: ECHO in potential penetrating cardiac injury YES YES> > 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 > >> > > **************************************> Get a sneak peek of the all-new> AOL> at >> http://discover.aol.com/memed/aolcom30tour> --> 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/> > --> 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/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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ECHO in potential penetrating cardiac injury YES YES