Saturday, November 5, 2011

Emergency Thoracotomy: Indications

When does a trauma patient in the ED need an emergent thoracotomy?

Accepted/relative indications
ANY  Penetrating thoracic injury
-Traumatic arrest, with or without previously witnessed cardiac activity
-Unresponsive hypotension (BP < 70mmHg)

Blunt thoracic injury
-Unresponsive hypotension (BP < 70mmHg)
-Rapid exsanguination from placed chest tube (>1500ml)
-Traumatic arrest with previously witnessed cardiac activity (relative indication)

Contraindications
- Blunt thoracic injuries with no witnessed cardiac activity
- Multiple blunt trauma
- Severe head injury
 

Acute MI? w/ LBBB- Sgarbossa's Criteria

It's hard to tell if a patient with LBBB  has an acute MI because ST segments are "appropriately discordant" with the terminal portion of the QRS
  • i.e., if  QRS is - (downgoing), the ST will normally be + (upgoing), and vice versa

In 1996, Sgarbossa et al looked through the GUSTO-1 trial patients with LBBB and AMI --> derived 3 criteria to help dx "hidden" AMI:

1. ST elevation ≥ 1 mm concordant with QRS complex (most predictive of AMI of the 3 criteria)
2. ST depression ≥ 1 mm in lead V1, V2, or V3
3. ST elevation ≥ 5 mm where discordant with QRS complex

 
Sources:

Monday, September 5, 2011

Internal Auditory Canal Anatomy


  • 7-up: facial n
  • coke down: cochlear n
  • SVN: sup vestibular n (superior & lateral semicircular canal; utricle)
  • IVN: inf vestibular n (posterior semicircular canal; saccule)
  • BB: Bill's bar (bony protrusion, separates ant/post)
Source: http://roentgenrayreader.blogspot.com/

Semicircular canal anatomy: