An unstable trauma patient may have an aortic tear with hemorrhage. Transesophageal echocardiography (TEE) may be useful for identifying these injuries, especially when the patient is too unstable for transport to an aortography suite. A patient at risk for a significant aortic injury can be identified based on the mechanism of injury and/or findings on the chest radiographs.


Indications for performing transesophageal echocardiography in a trauma patient:

(1) mechanism of injury, especially if associated with a pelvic fracture

(2) evidence of mediastinal hematoma

(3) fractures indicating significant kinetic energy transmission


Mechanism of injury:

(1) ejection from a vehicle

(2) death of another occupant in the same car

(3) fall from a height > 20 feet


Evidence of a mediastinal hematoma:

(1) widened mediastinum

(2) blurred aortic knob

(3) left pleural or apical cap

(4) depression of the left mainstem bronchus

(5) deviation of the trachea or nasogastric tube


Fractures indication significant kinetic energy:

(1) multiple rib fractures

(2) first and second rib fractures

(3) scapular fractures

(4) thoracic spine fractures


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