tipology:letter

numero rivista e pagine: HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 2(1): 55-56
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Penetrating chest trauma: the role of emergency echo

Authors: F. Guarracino*1, R. Baldassarri1, C. Vullo1, M. Stefani1

1Cardiothoracic Anaesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

Corresponding author: * Corresponding author:
Dr. Fabio Guarracino
Cardiothoracic Department Cardiothoracic Anaesthesia and Intensive Care Medicine
Azienda Ospedaliera Universitaria Pisana,
Via Paradisa, 2 - 56123 Pisa, Italy
E-mail: fabiodoc64@hotmail.com

A 38 year male was transferred to our Cardiothoracic Department with a long blade into the thorax following suicide attempt. On arrival in the operating room the blade moved synchronous with cardiac rhythm. Penetrating chest trauma is a class I indication for echocardiography [1], so a transthoracic echo study with Focus Assessed Transthoracic Echo (FATE) approach [2] was immediately and rapidly performed upon arrival in theatre, which showed the tip of the blade being close to the left ventricular apex (Figure 1) in the pericardial space, and excluded the presence of the blade within the heart.

 

 

figure 1

The tip of the blade is close to the left ventricular apex

 

Also no pericardial effusion was detected.
The echo exam changed the emergency surgery into a minimally invasive off-pump / close chest procedure: the surgeon simply pulled the blade out of the thorax (Figures 2, 3) and sutured the small skin cut.

 

 

Figure 2

Removal of the blade

 

 

Figure 3

The skin after removal of the blade

 

Once in the ICU the patient was monitored by continuous ECG and invasive arterial pressure, and successive transthoracic echo exams were performed at 3, 6 and 12 hours postoperatively in order to exclude the presence of pericardial effusion and prevent tamponade.

 

References

  1. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). American College of Cardiology Web Site 2003;
  2. Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care European Journal of Anaesthesiology 2004; 21: 700-707.