stabbed heart

[trauma at emergencyunit.com]

My favourite definition of pericardiocentesis is 'a needle with a clot at
both ends'. Agree with B - this is a clear indication for ED thoracotomy. I
also agree he should not have received any negatively inotropic drugs
beforehand; the only anaesthetic that should be considered (if anything) is
ketamine in this circumstance. However, they wake up astonishingly quickly
once cardiac output is restored so be ready to anaesthetise then!

Blueflightmedic. 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: 02 May 2007 03:30
To: trauma-list at trauma.org
Subject: Re: stabbed heart


"In my simple view, both needle pericardiocentesis and subxyphoid  
pericardiotomy should be removed from the ATLS and ACLS and PALS,  etc" 

ABSOLUTELY!  I couldn't agree with you more.  It is hard enough to suck
clots up with a sucker, let alone a 16 guage needle! Ron

>>> <KMATTOX at aol.com> 5/1/2007 9:57 PM >>>

In a message dated 5/1/2007 8:50:20 P.M. Central Daylight Time,  
p.bjorn at netzero.net writes:

Shows  what I know.  I hate it when that  happens.

Pret



Pret is RIGHT in his answer regarding what ATLS and many other courses  
teach.   However, I do not recall ever seeing a patient with a SW or  GSW to
the 
heart or pericardium benefit from either a needle pericardiocentesis  or a 
sub-xyphoid pericardiotomy.    I have seen a significant  number of people
"saved" 
by EC thoracotomy.    We still see  several patients per year who are 
victimized by the ATLS and ACLS  pericardiocentesis protocol and where blood
is 
retrieved via the probing needle  and then the patient gets worse.   At
thoracotomy 
the only injury  found is the needle stab wound to the heart, usually the 
right  ventricle.    
 
In my simple view, both needle pericardiocentesis and subxyphoid  
pericardiotomy should be removed from the ATLS and ACLS and PALS,  etc.   
 
k



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