2D or 3D TEEin penetrating cardiac injury

[IVAN HRONEK]

Rob,
 
don't tell me you want a thoracotomy with a pericardial window for a physiological pericardial effusion,
I just don't believe that.
 
I think this is the hard part where the surgeon has to be gentle..and do a little of medical management..
 
And also: the presence of a small amount of pericardial effusion without any other clinical signs of 
tamponade I do not think is an indication for a thoracotomy.Ivan Hronek MDChief, 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 17:04:02 -0400> Subject: RE: 2D or 3D TEEin penetrating cardiac injury> > 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> 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/--> 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/