2D or 3D TEEin penetrating cardiac injury

[Robert F. Smith]

Well if a big shard of glass or piece of metal somehow managed to pierce my
chest in the area of the box, I'd feel great about being worked up and
getting a window at least. We wouldn't echo unless penetrating injury. And
I'm not tough (total wimp), weathered (just aging), or a surgeon (you don't
even want to know), lol.

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 4:54 PM
To: Trauma & Critical Care mailing list
Subject: RE: 2D or 3D TEEin penetrating cardiac injury

 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
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