Ruptura traumática de músculo papilar da valva tricúspide com forame oval patente adquirido e ruptura atrial direita oculta / Traumatic tricuspid valve papillary muscle case with concomitant acquired patent foramen ovale and covert right atrial rupture

RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.

ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.

ICU handover procedure: the Greek perspective.

Background: Passing the right information poses a challenge in clinical practice. This is the first study in Greece that tries to describe the handover procedure in an intensive care unit to a tertiary hospital. Methods: A two phase study was conducted during a 155 days period. It included a blind and open observational study which examined the quality and content of clinical handover by night shift doctor to the medical team and a survey about the process. Retrospective cross-checking of the information handed over with one written down in the actual patient record was also conducted. Results: A total of 800 set of patients’ daily records were examined. A structure of system-based approach of the handover was recorded, with system coverage varying from 21% (nutrition) to 86% (respiratory system) and good relation with the actual record in most areas of interest. Other areas, such as comorbidities, and relatives’ issue were poorly covered. Education meeting that was held between the two phases did ameliorate the content and the quality of information passed over, and in some areas, proved to have a positive effect on certain aspect of handover like e.g. frequency of interruptions, infection status, relatives’ issues and proposed management plan coverage. Conclusions: Handover process is vital for maintaining stability and quality of care in intensive care unit. Its continual efficiency reevaluation is at least as important as the handover itself for preserving it as a valuable tool in everyday practice.