Liver Fracture & DVT
	Date: Sun, 15 Sep 1996 09:37:32 From: Michael F. Oswanski [mfoswanski@glasscity.net] Anxious to hear opinions on a difficult case: A 41 yowf RN was struck on the R side by a "waverunner" watercraft being driven (unbelievably) by a two year old (these devices can attain speeds of up to 50mph)at a nearby resort lake. She did not lose consciousness. Was rolled up and out of the water by family and tranported to a trauma center. Hemodynamics alsways stable with R sided abd pain and pelvic pain. Investigations reveal a grade II liver fx with hematoma on R and R sided pevic rami FX'x, stable. Admitted to ICU observed. HB as low as 8 but always hemodynamically stable, out of bed with very limited weight bearing on day 6, EPC's on continously. Repeat CT showed hematoma a little larger but no other problem and home on day 11 with bedrest to chair, family support and nursing care. Returns 4 days later with DVT that is confirmed on Doppler and has IVC filter placed by vascular surgeon she calls in consultation from vascular lab (RN remember!) Stable and doing well on low dose heparin. Thoughts: Would anyone use prophylactic low molecular weight heparin in such a situation? Prohylactic IVC filter? Any different management? Was it her destiny(critical care RN)?
	Date: Tue, 17 Sep 1996 11:35:55 From: Dr. Jay Smith [SSMITH4@surg.hmc.psu.edu] Where was DVT? Above or below knee? Was she getting some Physical Therapy at the time of her Hospitalization or when she went home besides limited weight bearing? I would not have done PROPHYLACTIC FILTER PLACEMENT. I might have placed her on Fragmin during her hospitalization after the first 48 hours depending on her size (she is an RN and if could easily be obese) or perhaps low dose Coumadin. However, this was probably her destiny and was treated appropriately.