ECHO in potential penetrating cardiac injury YES YES

[IVAN HRONEK]

Rob, that's the art of the nuances, you just have to do the right thing, you shouldn't have any misdiagnostic adventures and accept failures: you err on the side of safety for the patient as always.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: Fri, 7 Sep 2007 08:28:29 -0400> Subject: RE: ECHO in potential penetrating cardiac injury YES YES> > Ivan,> > This seems reasonable if you can reliably do it. Our problem has been how to> do this in a really busy trauma unit? Pts. Can get "lost" in the chaos for a> little while. Then it's like you're checking every couple hours or so which> we're not comfortable with. If you admit to the ward, even worse. > > I really don't think I'm knife happy, lol. The trauma surgeons are willing> to accept a certain level of positive but non therapeutic windows and not> miss any true injuries.> > Rob> > -----Original Message-----> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]> On Behalf Of IVAN HRONEK> Sent: Friday, September 07, 2007 7:09 AM> To: Trauma &amp; Critical Care mailing list> Subject: ECHO in potential penetrating cardiac injury YES YES> > Watch: pulse, skin temperature, CNS status, NIR, nailbed color etc q 30 min.> - if any of them got any worse 4 L IC thoracotomy and a HUGE pericardial> window within 5 minutes.> Or maybe nothing as he has been stable for 48 hrs.> Ivan> > > > > Date: Fri, 7 Sep 2007 10:14:50 +0200> From: Pradeep.Navsaria at uct.ac.za>> To: trauma-list at trauma.org> Subject: RE: 2D or 3D TEEin penetrating cardiac> injury No NO> > I have not been closely following the discussion, however I> present to you the following case seen in our unit this week - :> > Adult> male - referred from district hospital> > Praecordial stab Saturday -> referred Mon.> > Haemodynamically stable - no evidence of tamponade.> > CXR:> right haemothorax - ICD, straight left heart border, mediastinum normal> >> ECG: ST segment elevation - V2-V5> > Ultrasound (radiologist) - 6mm> effusion.> > WHAT WOULD YOU DO IN YOUR CENTER?> > > > CXR> > > > > > > >>>> IVAN HRONEK <ih7 at msn.com> 2007/09/07 07:25 am >>>> That's right - that's> what you do ! I agree.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> > > Date:> Fri, 7 Sep 2007 07:23:08 +0200> From: tch at sun.ac.za> To:> trauma-list at trauma.org> Subject: RE: 2D or 3D TEEin penetrating cardiac> injury No NO > > Rob> > Basics - CXR; to exclude the need for chest tube> (what were the lung sounds / percussion??)> FAST sonar for heart - would> watch with resonar 6hrly any effusion less than/= to 5mm.> > Nil else -> short stay ward. Regular clinical review.> > 85% of these are home in 24> hours.> > Tim> Dr T C Hardcastle> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)> ATLS instructor> and DSTC Cape Town Course Director> Intern program Coordinator: Surgery>> M.Med (Emergency Medicine) Executive Committee member> Clinical Head> (Director): Diana Princess of Wales Trauma Unit> Division of Surgery> (General) Room 4064> Department of Surgical Sciences> Tygerberg Hospital /> University of Stellenbosch> PO Box 19063> Tygerberg 7505> Western Cape>> South Africa> e-mail: tch at sun.ac.za> Cell: +27824681615> Office:> +27219389281 or 4911 pager 0302> > > > -----Original Message-----> From:> trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]On> Behalf Of Robert F. Smith> Sent: Friday, September 07, 2007 3:38 AM> To:> 'Trauma &amp; Critical Care mailing list'> Subject: RE: 2D or 3D TEEin> penetrating cardiac injury No NO > > > Ok so you have an 18 yr old male> presenting with a stab wound over the> precordium. His pulse is 90, BP> 110/70, RR 18. No retained missile. Would> you do any diagnostic studies and> why and what findings would you take> action on?> > Rob> > -----Original> Message-----> From: trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]> On Behalf Of KMATTOX at aol.com> Sent:> Thursday, September 06, 2007 9:19 PM> To: trauma-list at trauma.org> Subject:> Re: 2D or 3D TEEin penetrating cardiac injury No NO > > > In a message dated> 9/6/2007 8:14:04 P.M. Central Daylight Time, > rfsmithmd at comcast.net> writes:> > 3. With appropriate mechanism, and a positive finding on FAST,> what> clinical> findings are you going to wait to see?> > > > > A patient> with symptoms that matches the positive image seen on the FAST.> > It is> ludicrous to operate on a patient that does not need an operation,> put > a> stent graft in a patient without a vascular lesion, etc. > > VOMIT. Treat> and OPERATE on a patient NOT an image. The image test is > just a something> to aid in diagnosis. > > k > > > > **************************************> Get a sneak peek of the all-new AOL> at >> http://discover.aol.com/memed/aolcom30tour> --> 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/--> 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/