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Sadeghian M, Ebrahimi P, Soltani P, Ghasemi M, Taheri H, Mehrpooya M. Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report. Int J Emerg Med 2024; 17:87. [PMID: 39010011 PMCID: PMC11247804 DOI: 10.1186/s12245-024-00670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Blunt traumatic aortic injury (BTAI) is the second leading cause of death due to traumas in young patients. The primary presentation might be chest or interscapular pain, difficulty in breathing, and, in severe cases, hypotension. Considering the rapid deterioration of these patients' clinical conditions, prompt diagnosis and treatment initiation are crucial. In these injuries, the most involved parts of the aorta are the isthmus (distal to the left subclavian artery) and the descending part in the thorax. Therefore, the main diagnostic strategies include transthoracic echocardiography, CT angiography, and endovascular diagnostic approaches. Case presentation The patient was a 19-year-old male presenting with the symptoms of chest pain, dyspnea, and extremities excruciating pain after a car turnover. The initial evaluation showed no abnormal cardiovascular finding except bilateral hemothorax, addressed with chest tubes. Twelve hours later, when the patient was under observation for orthopedic surgeries, his chest pain and dyspnea started, and TTE and CTA showed a grade three descending aneurysm of the aorta. The patient was treated immediately with an endovascular procedure of stent implantation. A delayed debranching surgery was also performed, which resulted in desirable outcomes and uneventful follow-up. CONCLUSION Although open thoracic surgery is the main and almost the only option for treating aneurysms of the aorta in hemodynamically unstable patients, the endovascular procedure has shown superior outcomes in selected patients with appropriate anatomy. Debranching surgery, which can be done simultaneously or with delay after the initial procedure, has proven protective against thromboembolic cerebral events. CLINICAL KEY POINT Patients with an aneurysm of the aorta should be transported to a medical center with a multidisciplinary team for an urgent evaluation and treatment. The initial resuscitation and diagnosis are challenging, considering the fatal nature of these injuries, and the selection of the treatment is based on the patient's clinical condition and evaluated anatomy in cardiovascular imaging.
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Affiliation(s)
- Mohammad Sadeghian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran
| | - Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Soltani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Massoud Ghasemi
- Department of Interventional Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
| | - Homa Taheri
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maryam Mehrpooya
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Teran F, West FM, Jelic T, Taylor L, Jafry ZM, Burns KM, Owyang CG, Emt CC, Abella BS, Andrus P. Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med 2024; 76:164-172. [PMID: 38086182 DOI: 10.1016/j.ajem.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Over the past two decades, transesophageal echocardiography (TEE) has been used with increasing frequency to evaluate critically ill patients outside of traditional settings. The purpose of this study was to characterize the number of programs, users, practice characteristics, training and competency requirements and barriers for the current use of resuscitative transesophageal echocardiography (TEE) in Emergency Departments (EDs) in the United States and Canada. METHODS A closed internet-based, cross-sectional, point-prevalence survey was administered via email to 120 program directors of emergency ultrasound fellowships (EUSF) and 43 physicians from EDs without EUSF from the United States and Canada. RESULTS Ninety-eight percent of surveyed participants responded. Twenty percent of respondents reported having active resuscitative TEE programs. The majority of participating hospitals (70%) were academic centers with residency programs. A total of 33 programs reported using resuscitative TEE in their ED and of those, 82% were programs with EUSF. Most programs performing TEE (79%) had less than five attending physicians performing TEE. Evaluation of patients during resuscitation from cardiac arrest (100%) and post-arrest care (76%) are the two most frequent indications for TEE in the ED. The most common core elements of resuscitative TEE protocols used are: assessment of left ventricular (LV) systolic function (97%), assessment of right ventricular (RV) function (88%), evaluation of pericardial effusion / tamponade (52%). All programs reported using formal didactics in their training programs, 94% reported using high-fidelity simulation, and 79% live scanning of patients. Financial concerns were the most common barrier use of TEE in the ED (58%), followed by maintenance of equipment (30%), and credentialing/privileges (30%). CONCLUSIONS This study provides a snapshot of the practice of resuscitative TEE in EDs in the United States and Canada revealing the existence of 33 programs using this emerging modality in the care of critically ill patients.
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Affiliation(s)
- Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Frances Mae West
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, Pennsylvania, PA, USA
| | - Tom Jelic
- Department of Emergency Medicine, University of Winnipeg, Manitoba, MB, Canada
| | - Lindsay Taylor
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Zan M Jafry
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Katharine M Burns
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Clark G Owyang
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Joan and Stanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Claire Centeno Emt
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S Abella
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip Andrus
- Department of Emergency Medicine, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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Prager R, Walser E, Balta KY, Anton Nikouline MD, Leeper WR, Vogt K, Parry N, Arntfield R. Resuscitative transesophageal echocardiography during the acute resuscitation of trauma: A retrospective observational study. J Crit Care 2024; 79:154426. [PMID: 37757671 DOI: 10.1016/j.jcrc.2023.154426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Resuscitative transesophageal echocardiography (TEE) is an emerging POCUS modality that can be used to guide trauma resuscitation. METHODS Trauma patients who underwent TEE within 24 h of admission from 2013 to 2022 were prospectively identified. We retrospectively analyzed resuscitative TEE reports and patient charts in duplicate. RESULTS 29 providers performed TEE for 54 acute trauma patients. 28 (52%) died in hospital; 33 (61%) required operative intervention (<24 h). Median injury severity score was 29 [IQR 22-43]. The most common indications for TEE were hemodynamic instability (34, 63%), inadequate windows for transthoracic echocardiography (14, 26%) and cardiac arrest (11, 20%). There were no identified complications. A new diagnosis was made in 31 (57%) cases: most commonly right ventricular dysfunction (10, 19%), pericardial effusion (9, 17%), and hypovolemia (6, 11%). TEE ruled out major cardiac injury in 83% of cases. TEE changed resuscitative strategy, in 17 (32%) patients, diagnostic imaging approach in 6 (11%) patients, procedural or operative approach in 5 (9%) patients and disposition from the trauma bay in 4 (7%) patients. CONCLUSION Resuscitative TEE during acute trauma care has an additional diagnostic yield to existing diagnostic pathways and may impact definitive management for some patients in the trauma bay.
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Affiliation(s)
- Ross Prager
- Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
| | - Eric Walser
- Western University, Department of Surgery, Division of Critical Care Medicine, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria HospitalLondon Health Sciences Centre, 800 Commissioners Road, East PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Kaan Y Balta
- Western University, Faculty of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
| | - M D Anton Nikouline
- Western University, Division of Emergency Medicine, Division of Critical Care Medicine, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria HospitalLondon Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - William R Leeper
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Kelly Vogt
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Neil Parry
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Robert Arntfield
- Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
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Adi O, Fong CP, Tze MKH, Ahmad AH, Panebianco N, Ranga A. Transesophageal echocardiography (TEE)-guided transvenous pacing (TVP) in emergency department. Ultrasound J 2023; 15:35. [PMID: 37603103 PMCID: PMC10441836 DOI: 10.1186/s13089-023-00332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Placement of a temporary pacemaker is a vital skill in the emergency setting in patients that present with life-threatening bradycardia. Transvenous pacing is the definitive method of stabilizing the arrhythmia compared to transcutaneous pacing, as it provides more comfort and better control of heart rate, until the insertion of a permanent pacemaker. CASE REPORT In this case report, we describe the steps using TEE to guide the insertion of transvenous pacer at the emergency department. Traditionally, the process of floating a transvenous pacer wire is performed "blindly" using landmarks and a monitoring ECG finding for capture, or under transthoracic echocardiography (TTE) ultrasound guidance. The blind procedure is associated with higher rate of failure and complications. While guidance using TTE is associated with higher success rates and fewer complications, inadequate imaging of the right side of the heart may limit the utility of this imaging modality. The use of transesophageal echocardiography (TEE) by emergency medicine and critical care physicians has gained traction in recent years due to its clear images and lack of interference with procedures being performed on the chest. In this article, we describe a protocol using TEE to guide the insertion of transvenous pacer through a case illustration.
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Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Azma Haryaty Ahmad
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Nova Panebianco
- Division of Emergency Ultrasound, Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Asri Ranga
- Department of Cardiology, Serdang Hospital, Kajang, Selangor, Malaysia
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Mazzaccaro D, Righini P, Fancoli F, Giannetta M, Modafferi A, Malacrida G, Nano G. Blunt Thoracic Aortic Injury. J Clin Med 2023; 12:jcm12082903. [PMID: 37109240 PMCID: PMC10142366 DOI: 10.3390/jcm12082903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Fabiana Fancoli
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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Heinz ER, Keneally R, d'Empaire PP, Vincent A. Current status of point of care ultrasonography for the perioperative care of trauma patients. Curr Opin Anaesthesiol 2023; 36:168-175. [PMID: 36550092 DOI: 10.1097/aco.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The incorporation of point of care ultrasound into the field of anesthesiology and perioperative medicine is growing at rapid pace. The benefits of this modality align with the acuity of patient care and decision-making in anesthetic care of a trauma patient. RECENT FINDINGS Cardiac ultrasound can be used to diagnose cardiac tamponade or investigate the inferior vena cava to assess volume status in patients who may suffer from hemorrhagic shock. Thoracic ultrasound may be used to rapidly identify pneumothorax or hemothorax in a patient suffering chest wall trauma. In addition, investigators are exploring the utility of ultrasonography in traumatic airway management and elevated intracranial pressure. In addition, the utility of gastric ultrasound on trauma patients is briefly discussed. SUMMARY Incorporation of point of care ultrasound techniques into the practice of trauma anesthesiology is important for noninvasive, mobile and expeditious assessment of trauma patients. In addition, further large-scale studies are needed to investigate how point of care ultrasound impacts outcomes in trauma patients.
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Affiliation(s)
- Eric R Heinz
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
| | - Ryan Keneally
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
| | - Pablo Perez d'Empaire
- Department of Anesthesiology and Pain Medicine, Department of Anesthesia, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
| | - Anita Vincent
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
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Prager R, Bowdridge J, Pratte M, Cheng J, McInnes MDF, Arntfield R. Indications, Clinical Impact, and Complications of Critical Care Transesophageal Echocardiography: A Scoping Review. J Intensive Care Med 2023; 38:245-272. [PMID: 35854414 PMCID: PMC9806486 DOI: 10.1177/08850666221115348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Critical care transesophageal echocardiography (ccTEE) is an increasingly popular tool used by intensivists to characterize and manage hemodynamics at the bedside. Its usage appears to be driven by expanded diagnostic scope as well as the limitations of transthoracic echocardiography (TTE) - lack of acoustic windows, patient positioning, and competing clinical interests (eg, the need to perform chest compressions). The objectives of this scoping review were to determine the indications, clinical impact, and complications of ccTEE. METHODS MEDLINE, EMBASE, Cochrane, and six major conferences were searched without a time or language restriction on March 31st, 2021. Studies were included if they assessed TEE performed for adult critically ill patients by intensivists, emergency physicians, or anesthesiologists. Intraoperative or post-cardiac surgical TEE studies were excluded. Study demographics, indication for TEE, main results, and complications were extracted in duplicate. RESULTS Of the 4403 abstracts screened, 289 studies underwent full-text review, with 108 studies (6739 patients) included. Most studies were retrospective (66%), performed in academic centers (84%), in the intensive care unit (73%), and were observational (55%). The most common indications for ccTEE were hemodynamic instability, trauma, cardiac arrest, respiratory failure, and procedural guidance. Across multiple indications, ccTEE was reported to change the diagnosis in 52% to 78% of patients and change management in 32% to79% patients. During cardiac arrest, ccTEE identified the cause of arrest in 25% to 35% of cases. Complications of ccTEE included two cases of significant gastrointestinal bleeding requiring intervention, but no other major complications (death or esophageal perforation) reported. CONCLUSIONS The use of ccTEE has been described for the diagnosis and management of a broad range of clinical problems. Overall, ccTEE was commonly reported to offer additional diagnostic yield beyond TTE with a low observed complication rate. Additional high quality ccTEE studies will permit stronger conclusions and a more precise understanding of the trends observed in this scoping review.
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Affiliation(s)
- Ross Prager
- Division of Critical Care, Western University, Stn B. London, ON, Canada,Ross Prager, Critical Care Trauma Centre,
Victoria Hospital. Rm # D2-528 London Health Sciences Centre, 800 Commissioners
Rd. E, London, ON N6A 5W9, Canada.
| | - Joshua Bowdridge
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Pratte
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jason Cheng
- Division of Critical Care, Western University, Stn B. London, ON, Canada
| | - Matthew DF McInnes
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada, Clinical Epidemiology Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
| | - Robert Arntfield
- Division of Critical Care, Western University, Stn B. London, ON, Canada
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Girón-Arango L, D’Empaire PP. Is There a Role for Transesophageal Echocardiography in the Perioperative Trauma Patient? CURRENT ANESTHESIOLOGY REPORTS 2022; 12:210-216. [PMID: 35340714 PMCID: PMC8933763 DOI: 10.1007/s40140-022-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review
This review article summarizes the advantages and potential uses of focused transesophageal echocardiography (TEE) in the perioperative period for trauma patients. We suggest a locally developed TEE protocol for trauma and provide strategies to achieve widespread use of TEE in the anesthesia care of trauma patients. Recent Findings In recent years, TEE has gained interest as an additional modality as point-of-care ultrasound (POCUS) for the resuscitation of acutely ill patients in whom transthoracic echocardiography is not feasible or non-diagnostic. Nevertheless, its use among non-cardiac anesthesiologists is still limited compared to the more traditional POCUS applications. Summary A goal-directed, focused TEE can be performed at the bedside in different locations and mechanically ventilated patients. TEE provides relevant diagnostic information to guide the resuscitation of acutely injured patients, particularly to identify life-threatening hidden thoracic injuries in the scenario of patients with multi-system trauma.
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Adi O, Ahmad AH, Fong CP, Ranga A, Panebianco N. Resuscitative transesophageal echocardiography in the diagnosis of post-CABG loculated pericardial clot causing cardiac tamponade. Ultrasound J 2021; 13:22. [PMID: 33856577 PMCID: PMC8050179 DOI: 10.1186/s13089-021-00225-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Pericardial effusion is a known complication of post-open cardiac surgery which can progress to life-threatening cardiac tamponade. Classical signs of tamponade such as hypotension and pulsus paradoxus are often absent. Diagnosing acute cardiac tamponade with transthoracic echocardiography (TTE) can be challenging in post-cardiac surgical patients due to distorted anatomy and limited scanning windows by the presence of surgical dressings or scar. Additionally, this patient population is more likely to have a loculated pericardial effusion, or an effusion that is isoechoic in appearance secondary to clotted blood. These findings can be challenging to visualize with traditional TTE. Missed diagnosis of cardiac tamponade due to loculated pericardial clot can result in delayed diagnosis and clinical management. Case presentation We report a case series that illustrates the diagnostic challenge and value of resuscitative transesophageal echocardiography (TEE) in the emergency department (ED) for the diagnosis of cardiac tamponade due to posterior loculated pericardial clot in post-surgical coronary artery bypass graft (CABG) patients. Conclusions Cardiac tamponade due to loculated posterior pericardial clot post-CABG requires prompt diagnosis and appropriate management to avoid the potential for hemodynamic instability. Transesophageal echocardiography allows a rapid diagnosis, early appropriate referral and an opportunity to institute appropriate therapeutic measures. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00225-7.
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Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit, Department of Emergency and Trauma, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), 30400, Ipoh, Perak, Malaysia.
| | - Azma Haryaty Ahmad
- Resuscitation & Emergency Critical Care Unit, Department of Emergency and Trauma, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), 30400, Ipoh, Perak, Malaysia
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit, Department of Emergency and Trauma, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), 30400, Ipoh, Perak, Malaysia
| | - Asri Ranga
- Department of Cardiology, Hospital Serdang, Serdang, Selangor, Malaysia
| | - Nova Panebianco
- Division of Emergency Ultrasound, Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
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