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Mon, 04 Feb 2002 09:33:39 EST

In a message dated Mon, 4 Feb 2002  2:21:16 AM Eastern Standard Time, SJASMD@aol.com writes:

> At Kings County we obviously would have performed arteriography immediately after the CT scan showed a splenic injury as there is nothing on this CT scan that predicts the need for hemostasis. If the arteriogram shows no arterial injury or intrasplenic extravasation, he can avoid a stay in the ICU and be discharge in short order. If the arteriography showed intrasplenic extravasation, you could either observe him in an ICU and then operated if he continued to bleed, performed proximal splenic artery embolization at the time of the arteriogram and discharged him in 3 days or explored him right away.
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> Now that he returns to the hospital with a CT scan that shows recurrent subcapsular hematoma, I would perform an arteriogram and embolization, even if no extravasation was seen on the angio. 
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> If he receives transfusion I would consider that failure of nonoperative management. No reason for such an injury to require transfusion.
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> If you don't have an angiographer willing to take care of this, shame them into learning or hire one.
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> Sal Sclafani

Sal--
You deviate from the criteria and definitions the rest of the world uses for nonop management in your above comments--failure of nonop management means--think about it--having to go to surgery, an endpoint and definition you will find in every paper written on this topic.  Transfusion is not an operation or surgery--by your definition, angioembolization should also, and with more logic, be considered such a failure--that is a true invasive procedure, right?  Of course, it is not.  Transfusion is very commonly required for these injuries, and some have defined the need for surgery on the number of transfusions required.--now, transfusing without operating or trying to stop the blood loss in a case of active bleeding is flawed and misguided, I agree, but there is certainly a place for transfusing to replete an initial large loss of blood with bleeding now stopped, for instance.
Also, something the radiologist in you just will not accept, but let me try again--you do not need an angio to tell if someone is actively bleeding from a splenic injury--the PATIENT tells you this just fine!  Stable and normal vital signs rules out active bleeding better than an invasive maneuver and a shadow on a piece of celluloid ever will--and much more safely and cheaply.
ERF

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Splenic injury - non-op management?