Cardiac Tamponade - PLEASE READ

[Guest guest]

 Hi All:

 

 I heard about this, somewhere, probably on another continent, very very far

from us. Depends on how you look at it, it could be very close to us. I have no

personal contact with this situation, fortunately, but I can write the following

with a high degree of accuracy. In the interests of strengthening our profession

and not messing up like this, please read on:

 

Generally healthy male with moderate asthma goes for acupuncture performed by a

15+ yr western veteran of TCM Acupuncture. Three treatments later there is no

appreciable difference in his condition from the px's point of view. On this

third treatment a needle was inserted at L1, L2 bilaterally, and CV17. Soon

after insertion (within 15 minutes) patient reported a strange bubbling feeling

in his chest underneath the needle. *He was told that this was De Qi*, and the

needle was retained. Soon after this the patient reported feeling extremely

tired, and became clammy and sweaty. The needles were removed. After a short

discussion, the patient urinated in his pants. The clinic director/supervisor, a

Chiropractor, was called in. After a lot of rigamarole that lasted almost 1.5

hours, the patient (who was in a deep stupor during this whole process) was

finally taken to the hospital where he was discovered to have a pericardial sac

that was filling with

blood (presumably because of a tear from an acupuncture needle). He immediately

underwent emergency surgery and lived. Apparently he was very close to death

when he arrived in the hospital.

 

Salient facts and interpretations:

 

1. Negligence: not understanding what De Qi is or isn't, and a lackadaisical or

complacent attitude to an unusual presumed variant of De Qi.

2. Negligence: not recognising, or not acting upon, signs of yang collapse /

shock.

3. Negligence: allowing a " supervisor " to take control of the situation which

required immediate referral to hospital. The supervisor also did not seem to

recognise the severity of the situation, and left the choice of hospital

referral up to the patient!!! (The patient said no to several requests to take

him to the hospital.)

4. Accident: not knowing that in about 1 in 20 people there will be a *hole in

the sternum at the location of CV17 allowing direct access to the heart*.

 

*note: the sternal foramen (hole) does not necessarily show clearly on an x-ray

when it is present.

 

 Points directly on the sternum are considered low risk due to the presumed lack

of ability of a needle to penetrate the bone. This assumption is no longer

tenable, and only an extremely oblique insertion (10 degrees or less) with an

awareness of potential penetration through the sternum is advisable at this

point. Sternal foramen have differing expressions in different individuals; from

a clearly defined hole to a defect that is partially or wholly filled with

fibrous tissue.

 It is useful to note that this foraminal defect is associated with the five

delays of development, in particular pigeon chest/cleft chest.

 

 Please use the following PMIDs to access relevant abstracts in PubMed.

 

9072108

10803333

7723561

 

 

 Thanks,

 Hugo

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.middlemedicine.org

 

 

 

 

 

[Guest guest]

Hugo:

 

 

 

You are a cheery fellow.  Worsley wrote to thread a needle through CV 17, not

direct insertion.  I wonder how deep this acupuncturist went into the point.

 

 

 

Anne

 

Anne C. Crowley, L.Ac., Dipl.Ac.

www.LaPlataAcupuncture.com

 

-

" Hugo Ramiro " <subincor

" Traditional "

<Chinese Medicine >

Monday, April 26, 2010 12:01:53 PM GMT -05:00 US/Canada Eastern

 Cardiac Tamponade - PLEASE READ

 

 

 

 

 

 

 Hi All:

 

 I heard about this, somewhere, probably on another continent, very very far

from us. Depends on how you look at it, it could be very close to us. I have

no personal contact with this situation, fortunately, but I can write the

following with a high degree of accuracy. In the interests of strengthening our

profession and not messing up like this, please read on:

 

Generally healthy male with moderate asthma goes for acupuncture performed by a

15+ yr western veteran of TCM Acupuncture. Three treatments later there is no

appreciable difference in his condition from the px's point of view. On this

third treatment a needle was inserted at L1, L2 bilaterally, and CV17. Soon

after insertion (within 15 minutes) patient reported a strange bubbling feeling

in his chest underneath the needle. *He was told that this was De Qi*, and the

needle was retained. Soon after this the patient reported feeling extremely

tired, and became clammy and sweaty. The needles were removed. After a short

discussion, the patient urinated in his pants. The clinic director/supervisor,

a Chiropractor, was called in. After a lot of rigamarole that lasted almost 1.5

hours, the patient (who was in a deep stupor during this whole process) was

finally taken to the hospital where he was discovered to have a pericardial sac

that was filling with

blood (presumably because of a tear from an acupuncture needle). He immediately

underwent emergency surgery and lived. Apparently he was very close to death

when he arrived in the hospital.

 

Salient facts and interpretations:

 

1. Negligence: not understanding what De Qi is or isn't, and a lackadaisical or

complacent attitude to an unusual presumed variant of De Qi.

2. Negligence: not recognising, or not acting upon, signs of yang collapse /

shock.

3. Negligence: allowing a " supervisor " to take control of the situation which

required immediate referral to hospital. The supervisor also did not seem to

recognise the severity of the situation, and left the choice of hospital

referral up to the patient!!! (The patient said no to several requests to take

him to the hospital.)

4. Accident: not knowing that in about 1 in 20 people there will be a *hole in

the sternum at the location of CV17 allowing direct access to the heart*.

 

*note: the sternal foramen (hole) does not necessarily show clearly on an x-ray

when it is present.

 

 Points directly on the sternum are considered low risk due to the presumed

lack of ability of a needle to penetrate the bone. This assumption is no longer

tenable, and only an extremely oblique insertion (10 degrees or less) with an

awareness of potential penetration through the sternum is advisable at this

point. Sternal foramen have differing expressions in different individuals; from

a clearly defined hole to a defect that is partially or wholly filled with

fibrous tissue.

 It is useful to note that this foraminal defect is associated with the five

delays of development, in particular pigeon chest/cleft chest.

 

 Please use the following PMIDs to access relevant abstracts in PubMed.

 

9072108

10803333

7723561

 

 Thanks,

 Hugo

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.middlemedicine.org