SW to heart

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Question from the antipodes...
I am aware of the apparent fraught medico-legal milieu in which the
North Americans unenviously find themselves. Given this, should list
members not be a little pensive about airing their management options on
a contentious case in a publically accessible forum? - Or is this not
really a risk in reality?

Rob Ojala
New Zealand

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson
Sent: Tuesday, 2 December 2008 12:57 a.m.
To: Trauma International emailing list
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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