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Tue Dec 2 18:08:14 GMT 2008

Errington

Occult esophagus injury in Z1 or 2 is not uncommon. CT is NOT yet good
enough to exclude an injury. A contrast swallow together with Angio or CTA
will exclude all injuries and enable non-op management if no significant
injury. If there are hard signs of a vascular injury explore for Z2, while
first image stable Z1's even with hard signs as endovasclar rx may be an
option.

See our study on the esophagus currently in-press EMJ - not sure which
issue it will be in. Basically we showed that an iso-oncotic swallow will
detect 100% of signficant abnormalities without the need for other
studies, except vascular injuries, which are approached either with
empiric Z1 imaging or clinical Z2 management.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
> Tim -
>
> Why the contrast swallow?
>
> Errington C. Thompson, MD
> Trauma/Surgical Critical Care
> Talk Show Host - WPEK
> www.whereistheoutrage.net
> Asheville, NC
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Dr Timothy Hardcastle
> Sent: Monday, December 01, 2008 2:14 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: SW to heart
>
> Errington
>
> I would explore the neck after a contrast swallow if positive or if hard
> signs and in zone 2. Otherwise would have observed both injuries.
>
> Tim
>
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer UKZN Dept Surgery
> Deputy Director - IALCH Trauma Service
>> 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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