ECHOCARDIOGRAPHY IN THORACIC TRAUMA - 09/09/11
Résumé |
Echocardiography (echo) is a well-known diagnostic technique used in the workup of both blunt and penetrating thoracic trauma. A skilled cardiac sonographer can obtain comprehensive anatomic and functional information assessing the heart, but even in some Level I trauma centers, cardiologists or trained echocardiographers are not readily available 24 hours a day.1, 21, 39 In the initial evaluation of the acutely injured patient, however, a focused, limited echo examination can provide the critical information the clinician needs to make decisions such as immediate surgery versus further diagnostic workup. For this reason, as stated previously, the use of focused bedside ultrasonography by emergency physicians and trauma surgeons is rapidly increasing in North America. The focused examination cannot replace formal echocardiography in the amount and quality of information obtained; its value lies in the fact that it can provide time-critical information when and where it is needed, 24 hours a day in the emergency department (ED), where acutely injured patients present. Current use of this technique by the trauma clinician centers on the identification of traumatic pericardial effusion (hemopericardium).
The detection of pericardial effusion (PE) in victims of chest trauma is one of the most critical applications of emergency bedside ultrasonography. The presence of PE may indicate significant cardiac injury and impending cardiac tamponade, so that its early detection immediately impacts patient management decisions and may decrease the time to definitive surgical care, thus optimizing chances for good outcomes. Emergency physicians and trauma surgeons who initially evaluate these patients are ideally positioned to make this diagnosis rapidly. Clinical signs and symptoms of PE and cardiac tamponade, however, are notoriously unreliable.15 It is therefore essential that these clinicians be familiar with the indications and limitations of echocardiography and ideally be able to perform a focused bedside two-dimensional echocardiographic examination to detect pericardial effusion.23
Two-dimensional echocardiography (or 2-D echo) is the formal term for real-time ultrasound examination of the heart.18 The most common and readily available technique is the transthoracic echocardiography (TTE). The TTE is performed by placing an ultrasound transducer (2.0 to 2.5 MHz for thick-chested adults, 3.5 MHz for normal adults, and 5 MHz for children) on the surface of the thorax overlying the standard imaging windows (parasternal, apical, and subcostal) to the heart (Figure 1, Figure 2, and Figure 3.18, 24 TTE has been used successfully by emergency physicians and trauma surgeons to detect PE in trauma victims.33, 36, 43, 46 More recently, transesophageal echocardiography (TEE) has emerged as a technique useful for early detection of both cardiac and aortic injuries. TEE is a more invasive approach that requires a higher level of expertise and personnel and thus far is performed mainly by cardiologists. TEE can be performed in the resuscitation area to make critical diagnoses rapidly, so that emergency physicians and trauma surgeons should be familiar with this technique and work with cardiologists to ensure immediate availability of this important diagnostic modality.32
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| Address reprint requests to Dennis Chan, MD, UCSD Medical Center, Department of Emergency Medicine, 200 West Arbor Drive, San Diego, CA 92103–8676 |
Vol 16 - N° 1
P. 191-207 - février 1998 Retour au numéro
Article précédent
- THE EMERGING ROLE OF BEDSIDE ULTRASONOGRAPHY IN TRAUMA CARE
- Scott W. Melanson, Michael Heller
- TRAUMA IN PREGNANCY
- Sean O. Henderson, William K. Mallon
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