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Mon Dec 1 20:15:54 GMT 2008

Dr. Bromberg,

This is also our practice.

Thank you, 

- MRM

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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
Sent: Monday, December 01, 2008 12:16 PM
To: trauma-list at trauma.org
Subject: Re: SW to heart

My understanding is that a negative FAST (or formal echo) is unreliable in the setting of hemothorax as it is possible that the hemopericardium is decompressing into the chest (as in this  case). Our practice in a case such as this would be pericardial window, followed by sternotomy for positive window. We don't do enough heart trauma to be comfortable watching a positive window that clears with lavage as recommended earlier.

Bill Bromberg

>>> <jpcut2cure at aol.com> 12/1/2008 12:27 PM >>>
I would have obtained a formal ECHO as I dont always trust my FAST, just being honest

john porter
university of mississippi

-----Original Message-----
From: Errington Thompson <errington at erringtonthompson.com>
To: Trauma International emailing list <trauma-list at trauma.org>
Sent: Mon, 1 Dec 2008 5:56 am
Subject: SW to heart

Question - I had a gentleman who tried to end it all the other night.  He had a SW (slash) to the neck and a single SW inside the cardiac box.  The patient was hemodynamically stable.  CXR revealed a left effusion.  I did a FAST in the ER then I CT of the chest with contrast.  My FAST was negative for pericardial fluid.  The CT was read as a small amount of fluid at the apex of the heart.  I took the patient to the OR and explored the neck wound.  Left chest tube 500cc out then nothing.  Who would have explored this patient's chest?  

Next morning the patient's heart rate was 100- 110.  BP 120/70.  Partner takes the patient to the OR for a pericardial window.  It is positive.
Cardiac surgery finds a non-bleeding laceration to the left ventricle.  Who would have taken this patient to the OR?

Thoughts?

Errington C. Thompson, MD, FACS, FCCM

Trauma/Surgical Critical Care

Talk Show Host - WPEK 880 AM

Asheville, NC 

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SW to heart