Fellow, Trauma Burns and Surgical Critical Care
Brigham and Women's Hospital
Pictures worth a 1000 words....
This is a CT scan of the chest of a young man with stab wound to the chest - he was hemodynamically stable on presentation but the location of the wound was concerning for cardiac injury and risk of tamponade. Because echocardiography is not readily available, a CT was performed and shows substernal air pockets just anterior the heart and aorta. While he may have been observed in the ICU and followed with serial echo exams in the American setting, lack of close monitoring capacity in the ICU, difficulties in mobilizing an operating room in case of sudden tamponade and lack of echo facilities meant that this patient needed an immediate pericardial window and if positive, a sternotomy to assess and possibly repair the likely injury to the heart.
Below- Intraoperative photograph showing open pericardium with a small (2mm) injury to the right heart. The injury had stopped bleeding and did not require further repair. This was a non-therapeutic sternotomy.
Trauma Resuscitation Bay in the Emergency ward at Baragwanath Hospital. Up to 16 patients can be managed and ventilated at one time. Considered the largest trauma center in the world.
Milpark Hospital, a private facility for insured patients, has a beautiful 30 bed Trauma ICU and a 10 bed Burn ICU, pictured below, with state of the art equipment and staff. The helipad is right in front of the entrance.
