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penetrating cardiac injury

kmattox at aol.com kmattox at aol.com
Mon Dec 21 01:44:45 GMT 2009

How many of your institutions have perfusionist  stand-by/?in-house for 
urgent bypass in these cases?
----We have perfusions we can call in for either trauma or other  cardiac 
surgery.  Two of our truama (cardiac surgeons) are very comfortable  in 
priming the pump and running it if necessary until the perfusionists get into  
the hospital.   

Who among the trauma surgeons is trained to feel comfortable placing  
someone on bypass a opposed to calling in a cardiac surgeon?   
---Almost 1/3 of our surgeons taking trauma call are comfortable in  
cannulating a heparinized patient to be ready for the pump when it is  primed.    

Who has experience using adenosine to simplify suturing/stapling?  
---We have not used adenosine, not really needed.    
In the case described, I would have used inflow occlusion after I had  
prepared sutures on a couple of LARGE needles in an attempt to closure the  
traumatic VSD just under or adjacent to the surface stab wound.   I  would snug 
down, but not tie the sutures until I was able to show that I had  occluded 
the SW VSD.   Only if I was unable to  close it off pump  from the surface 
of the heart.  

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