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.<sup>1 Aaland M.O., Bryan F.C., Sherman R. Two-dimensional echocardiogram in hemodynamically stable victims of penetrating precordial trauma Am Surg 1994 ;  60 : 412-415

Cliccare qui per andare alla sezione Riferimenti, 21 Freshman S.P., Wisner D.H., Weber C.J. 2-D echocardiography: Emergent use in the evaluation of penetrating precordial trauma J Trauma 1991 ;  31 : 902-905  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 39 Minard G., Schurr M.J., Croce M.A. , e al. A prospective analysis of transesophageal echocardiography in the diagnosis of traumatic disruption of the aorta J Trauma 1996 ;  40 : 225-230  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>15 Demetriades D., Van Der Veen B.W. Penetrating injuries of the heart: Experience over two years in South Africa J Trauma 1983 ;  23 : 1034-1041

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>23 Hauser A.M. The emerging role of echocardiography in the emergency department Ann Emerg Med 1989 ;  18 : 1298-1303  [cross-ref]

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Two-dimensional echocardiography (or 2-D echo) is the formal term for real-time ultrasound examination of the heart.<sup>18 Feigenbaum H. The echocardiographic examination   Feigenbaum H: Echocardiography Philadelphia: Lea & Febiger (1994). 

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>18 Feigenbaum H. The echocardiographic examination   Feigenbaum H: Echocardiography Philadelphia: Lea & Febiger (1994). 

Cliccare qui per andare alla sezione Riferimenti, 24 Henry W.L., DeMaria A., Gramiak R. , e al. Report of the American Society of Echocardiography Committee on nomenclature and standards in two-dimensional echocardiography Circulation 1980 ;  62 : 212-217

Cliccare qui per andare alla sezione Riferimenti</sup> TTE has been used successfully by emergency physicians and trauma surgeons to detect PE in trauma victims.<sup>33 Ma O.J., Mateer J.R., Ogata M. , e al. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians J Trauma 1995 ;  38 : 879-885

Cliccare qui per andare alla sezione Riferimenti, 36 Mayron R., Gaudio F.E., Plummer D. , e al. Echocardiography performed by emergency physicians: Impact on diagnosis and therapy Ann Emerg Med 1988 ;  17 : 150-154  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 43 Plummer D., Brunette D., Asinger R. , e al. Emergency department echocardiography improves outcome in penetrating cardiac injury Ann Emerg Med 1992 ;  21 : 709-712  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 46 Rozycki G.S., Ochsner M.G., Jaffin J.H. , e al. Prospective evaluation of surgeons' use of ultrasound in the evaluation of trauma patients J Trauma 1993 ;  34 : 516-526  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>32 Kearney P.A., Smith W., Johnson S.B. , e al. Use of transesophageal echocardiography in the evaluation of traumatic aortic injury J Trauma 1993 ;  34 : 696-701  [cross-ref]

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