List Archives

Sat, 12 Jan 2002 21:56:40 +0400

Subject;Re;  Venting Subcutaneous emphysema

The  venting  the  space above  manubrium sterni  by an incision does not
appear  to be  solution.
Days  have passed  the leak has not stopped.Is there  a  mediatinal
emphysema seen on chest X ray?
The   site of injury  has to be addressed.
Can I get  an X ray pic  in the  email
Thanks
Dr Raza
Khoula Hospital,Muscat,Oman
----- Original Message -----
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Sent: Saturday, January 12, 2002 4:05 PM
Subject: trauma-list digest, Vol 1 #1240 - 3 msgs


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> Today's Topics:
>
>    1. Re: Venting subcutaneous emphysema (Haim and Daphna Paran)
>    2. Re: forward aid team / medical aid team (David.Adler@pha.phila.gov)
>    3. Re: a new case - hypovolemic changes seen in CT (Avi Roy Shapira)
>
> --__--__--
>
> Message: 1
> Date: Fri, 11 Jan 2002 18:40:53 +0200
> From: Haim and Daphna Paran <Paran620@green.co.il>
> Subject: Re: Venting subcutaneous emphysema
> To: trauma-list@trauma.org
> Reply-To: trauma-list@trauma.org
>
> <html><head></head><body>Hi,<br>
> He probably needs a second chest tube probably anterior. There is no need
for "vents", they are myths.<br>
> <br>
> Haim Paran MD<br>
> Dept. of surgery "A"<br>
> Meir Hospital, Kfar-Sava<br>
> Israel <br>
> <br>
> Ronald Simon wrote:<br>
> <blockquote type="cite" cite="mid:3C3B8942.1090003@nyc.rr.com">I have a
case i'd like your opinion on. Sorry for the multi listing but
> this problem crosses specialties.
> <br>
>   <br>
> A 48 yo woman victim of MVC. Has multiple rib fx, pulm contusions, R
> pneumothorax for which a chest tube was placed. Patient now several days
> out chest tube still has small airleak, lung is up on chest xray. She
> has over the last few days developed significant subcut emphysema of her
> chest and face. My collegue wants to place a mediastinal "vent" (small
> incision above the manubrium to allow the air to escape). This does not
> make sense to me but in trying to be open minded i'm wondering if this
> is a described treatment. As far as i'm concerned as long as the chest
> tube is controlling the leak, the SQ air is unsightly and has no adverse
> effects unlike making a connection between the mediastinum and the
> outside world.
> <br>
> Thanks for your input
> <br>
> Ron Simon, MD
> <br>
> Jacobi Medical Center
> <br>
> Bronx, NY
> <br>
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> Message: 2
> Subject: Re: forward aid team / medical aid team
> To: trauma-list@trauma.org
> From: David.Adler@pha.phila.gov
> Date: Sat, 12 Jan 2002 05:45:16 -0500
> Reply-To: trauma-list@trauma.org
>
>
> Claire,
>
> I'm not sure what kind of SOPs you're looking for.  If your forward aid
> teams are tactical EMS providers, I can help you out.  Even if they're
not,
> if you expound a bit on what you need, I may be able to help you out.
>
> Sergeant David Adler #100, EMT-P
> Police Dept., City of Philadelphia Housing Authority
> Tactical Medic-SWAT
> David.Adler@pha.phila.gov
>
> Opinions expressed are solely those of the author, and do not reflect the
> official positions of the City of Philadelphia, the Philadelphia Housing
> Authority or the Housing Authority Police Department.
>
>
>
> --__--__--
>
> Message: 3
> Date: Sat, 12 Jan 2002 13:52:28 +0200 (IST)
> From: Avi Roy Shapira <avir@bgumail.bgu.ac.il>
> To: trauma-list@trauma.org
> Subject: Re: a new case - hypovolemic changes seen in CT
> Reply-To: trauma-list@trauma.org
>
> On Sat, 5 Jan 2002 KMATTOX@aol.com wrote:
>
> > Next someone will write an article about the ability of CT to determine
> > hematocrit, blood alcohol levels, and bilirubin levels.
>
>
> In truth, it may be possible.  Few people, even cardiologists, know that
> there are ECG changes typical to coma.  There are. Skilled ECG
> interpreters can tell that a patient is in coma, without seeing the
> patient.
>
> The pitch and pattern of a murmur is very telling. Some past generation
> cardiologists could listen to the heart, and tell you the pressure
> gradient across the pulomonic or mitral valve.
>
> Both skills are awesome. But are they of any use?  Do you need an ECG to
> diagnose coma, or would anyone operate on the pulmonic valve without a
> cath?
>
> It is quite possible that a skilled radiologist can read hypovolemia on
> the CT scan images. However, it is just as useless as reading coma on an
> ECG.
>
> Avi
>
>
> ==========================================================================
> Aviel Roy-Shapira, M.D.              Soroka University Hospital &
> Dept. of Surgery A. and              Ben-Gurion University Medical School
> the Critical Care Unit               POB 151, Beer Sheva, Israel
>
> email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390
>
>
>
>
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