New diagnostic techniques in trauma.

Advances in diagnostic and therapeutic interventions originally intended for use under elective circumstances have been applied to the trauma victim. This review examines the use of three of these techniques--transesophageal echocardiography (TEE), laparoscopy, and thoracoscopy--in the evaluation and treatment of the trauma patient. Initial experiences with TEE show it to be superior to transthoracic echocardiography in the evaluation of the heart. In limited studies, TEE appears to have the sensitivity to use as a screening tool for aortic disruption; however, it is severely limited by its ability to evaluate the distal aorta only. TEE cannot be used to visualize the ascending aorta or brachiocephalic vessels, which may account for 15% to 20% of injuries. Use of laparoscopy has been reported in more than 350 patients. Its primary use appears to be in decreasing negative and nontherapeutic laparotomies associated with penetrating trauma. The ability to operate through the scope continues to increase as additional improvements in instrumentation are introduced. Thoracoscopy has recently been shown to be able to evacuate retained hemothoraces and even drain empyemas and decorticate the pleural cavity.