2D or 3D TEEin penetrating cardiac injury

[IVAN HRONEK]

 ok, you guys are tough weathered surgeons I understand...
However...a small amount of pericardial effusin is present in a ceertain percentage of normal people, perhaps you have some.
How are you going to feel if you have a small (or medium-sized) fender-bender and your trauma surgeons opens your chest and pericardium for your physiological pericardial effusion ?Ivan Hronek MD Chief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020



> From: rfsmithmd at comcast.net> To: trauma-list at trauma.org> Date: Thu, 6 Sep 2007 16:44:36 -0400> Subject: RE: 2D or 3D TEEin penetrating cardiac injury> > Ivan,> > I was just skimming your post and noticed the "even small amounts of> fluid... etc." so I figured you would intervene for same. A long long time> ago in a hospital far away, the cardiologist would sometimes say "Echo> positive only for small amount of physiologic fluid." Then one of those> patients fell over while having a bowel movement because he had tamponade.> Since then all penetrating injuries to the "box" gets an echo ANY fluid> requires surgical intervention. This approach has proven beneficial many> times.> > Rob Smith> > -----Original Message-----> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]> On Behalf Of IVAN HRONEK> Sent: Thursday, September 06, 2007 2:49 PM> To: Trauma & Critical Care mailing list> Subject: 2D or 3D TEEin penetrating cardiac injury> > Matt,> > obviously, you know 2D TEE is best, and now 3D TEE is becoming available.> We recently found a small pericardial effusion in a GSW to L chest - > I advised to watch the patient as the etiology of the effusion obviously at> that one instance of examination wasn't clear.> As you know acute pericardial tamponade can happen even with small volumes> of effusion as the peridcardium hasn't been "stretched" by a slowly> accumulating effusion.> > What are people's experiences with tamponade - I am sure there are millions> of horrendous stories....> > Anybody has a better way than just watching the patient ?> Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.> > > > > Date: Thu, 6 Sep 2007 19:35:45 +0100> From: mgreeds at reeds.uk.com> To:> trauma-list at trauma.org> Subject: ECG in penetrating cardiac injury> >> Sa'ad,> > I once questioned the role of ECGs in demonstrating penentrating> cardiac > injury. Unfortunately, I never got round to conducting a full> review of > the literature but I have cited a few articles below which I >> provisionally found some time ago.> > I am not aware of any significantly> powered and properly conducted > studies to demonstrate the effectiveness of> ECGs (I would nevertheless be > keen to hear from others on the list who> have any enlightening data > either way.) My belief is that it does not have> any real role as there > have been a number of penetrating cardiac injuries> documented which do > not demonstrate any ECG changes and would have been> missed if relied upon > as a single diagnostic test.> > > Absence of> hemodynamic and ECG changes in a patient with traumatic left > ventricular> injury and puncture of the left anterior descending branch. > Südkamp M,> Geissler HJ, de Vivie ER. Thorac Cardiovasc Surg. 2000 Dec;48> (6):373-5.> >> Penetrating cardiac trauma: follow-up study including > electrocardiography,> echocardiography, and functional test. Duque HA, > Florez LE, Moreno A,> Jurado H, Jaramillo CJ, Restrepo MC. World J Surg. > 1999 Dec;23(12):1254-7.> (About post-operative monitoring NOT diagnostics)> > Dysrhythymia from an> intrapericardial air gun pellet: a case report. > Willemsen P, Kuo J, Azzu> A. Eur J Cardiothorac Surg. 1996;10(6):461-2. > (Anecdotal case.)> > > The> literature mostly refers to echocardiography being a much more useful > test> (greater sensitivity and specificity.) Although the last publication > above> refers to ECG changes being better at diagnosing penetrating > cardiac> injury in that particular case than echocardiography.> > I feel that nothing> can compare to appropriate histroy, examination of > the patient, mechanism> of injury (e.g. knife stab wound to anterior chest > = high probability of> cardiac injury until proved otherwised etc.) and > echo/FAST etc. are more> appropriate in making a proper diagnosis.> > > Matthew> > --> trauma-list :> TRAUMA.ORG> To change your settings or unsubscribe visit:>> http://www.trauma.org/index.php?/community/--> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/