Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

R: Renal injury - Part 1r

Dr. Filippo Di Carlo trauma-list@trauma.org
Fri, 4 Apr 2003 15:16:59 +0200


This is a multi-part message in MIME format.

------=_NextPart_000_0000_01C2FABD.3D069640
Content-Type: text/plain;
	charset="iso-8859-1"
Content-Transfer-Encoding: 7bit

Excuse me
but the problem i think is "When,how much trauma is relevant ?"

Filippo Di Carlo MD Naples
  -----Messaggio originale-----
  Da: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]Per
conto di hey@dadlnet.dk
  Inviato: domenica 30 marzo 2003 10.27
  A: trauma-list@trauma.org
  Oggetto: Re: Renal injury - Part 1r


  Karim
  Interesting. We are discussing our proceedures. I think the that are
changes comming  from the "classical" methodology which  can be --
  If the person has had "relevant" trauma and is stable, >CT.   (that means
probably most)
  If the person has had "relevant" trauma and is stable and is mentally
unclear > CT (all)
  If the person is unstable, FAST and OR, or just OR.
  (Like everything else there are exceptions, )
  Some people here think FAST with stable patients wasts time (the patients,
the surgeons, the radiologists) - they usually end up in the CT anyway. Why
not do it early, rather than later when there are symptoms. The decision is
based on -is there "relevant trauma" . I can not say if it is right or wrong
or supported by studies.

  By the way, when we start a TRAUMA SCAN, it is the whole proceedure
(cerebrum, cervical, thorax-ab-pelvis)
  We do not do - a little this, a little that.
  Friday we had a 80 year old woman who fell down stairs and hit her head
(?) . The person who did the
  initial physical examination, said she was ok,  stable and could account
for herself, - just scan the head. When she came to the scanner, she
appeared drowsy. (epidual hematom, contusion bleedning  contra coup,
  scapula fracture, 3 costa fractures on one side with accompanying small
pleural hematoma/bleedning, 2 on the other side, and a probably old but
serious compresion fracture of TH12).
  Regards   Mike H


    ----- Original Message -----
    From: Karim Brohi
    To: trauma-list@trauma.org
    Sent: Saturday, March 29, 2003 10:56 PM
    Subject: RE: Renal injury - Part 1r


    Not quite Andrew

    Patient arrives
    Haemodynamically unstable - do FAST
    Haemodynamically stable - observe / examine / CT

    FAST does not help decision making in haemodynamically stable blunt
abdominal trauma.
    FAST positive -> CT.  FAST negative -> CT.
    Good practice though.

    Karim
      -----Original Message-----
      From: trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org]On Behalf Of Andrew J Bowman
      Sent: 29 March 2003 18:48
      To: trauma-list@trauma.org
      Subject: Re: Renal injury - Part 1r


      Patient arrives, do FAST, find fluid.  Patient is stable do CT, find
injury, next step based on injury and stability.

      AJB
        ----- Original Message -----
        From: hey@dadlnet.dk
        To: trauma-list@trauma.org
        Sent: Saturday, March 29, 2003 9:41 AM
        Subject: Re: Renal injury - Part 1r


        Doc Rick
        I am curious. I scan, and find fluid. The patient is stable. what
now?
        Mike

------=_NextPart_000_0000_01C2FABD.3D069640
Content-Type: text/html;
	charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META http-equiv=3DContent-Type content=3D"text/html; =
charset=3Diso-8859-1">
<META content=3D"MSHTML 6.00.2600.0" name=3DGENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><SPAN class=3D806201009-04042003><FONT face=3DArial color=3D#0000ff =
size=3D2>Excuse=20
me</FONT></SPAN></DIV>
<DIV><SPAN class=3D806201009-04042003><FONT face=3DArial color=3D#0000ff =
size=3D2>but=20
the problem i think is "When,how much trauma is relevant =
?"</FONT></SPAN></DIV>
<DIV><SPAN class=3D806201009-04042003><FONT face=3DArial color=3D#0000ff =

size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D806201009-04042003><FONT face=3DArial color=3D#0000ff =

size=3D2>Filippo Di Carlo MD Naples</FONT></SPAN></DIV>
<BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
  <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
  size=3D2>-----Messaggio originale-----<BR><B>Da:</B>=20
  trauma-list-admin@trauma.org =
[mailto:trauma-list-admin@trauma.org]<B>Per conto=20
  di </B>hey@dadlnet.dk<BR><B>Inviato:</B> domenica 30 marzo 2003=20
  10.27<BR><B>A:</B> trauma-list@trauma.org<BR><B>Oggetto:</B> Re: Renal =
injury=20
  - Part 1r<BR><BR></FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>Karim</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>Interesting. We are discussing our =
proceedures. I=20
  think the that are&nbsp;changes comming &nbsp;from the "classical" =
methodology=20
  which&nbsp;&nbsp;can be --</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>If the person has had "relevant" =
trauma and is=20
  stable, &gt;CT.&nbsp; &nbsp;(that means probably most)</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>If the person has had "relevant" =
trauma&nbsp;and=20
  is stable and is mentally unclear &gt; CT (all)</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>If the person is unstable, FAST and =
OR, or just=20
  OR.</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>(Like everything else there are=20
  exceptions,&nbsp;)</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>Some people here think FAST with =
stable patients=20
  wasts time (the patients, the surgeons, the radiologists) - they =
usually end=20
  </FONT><FONT face=3DArial size=3D2>up in the CT anyway. Why not do it =
early,=20
  rather than later when there are symptoms. The decision </FONT><FONT=20
  face=3DArial size=3D2>is based on -is there "relevant trauma" . I can =
not say if=20
  it is right or wrong or supported by studies.</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>By the way, when we start a TRAUMA =
SCAN, it is=20
  the whole proceedure (cerebrum, cervical, =
thorax-ab-pelvis)</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>We do not do - a&nbsp;little this, a =
little=20
  that.</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>Friday we had a 80 year old woman who =
fell down=20
  stairs and hit her head (?) . The person who did the</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>initial physical&nbsp;examination, =
said she was=20
  ok, &nbsp;<U>stable</U> and&nbsp;could account for herself, - just =
scan the=20
  head. When </FONT><FONT face=3DArial size=3D2>she came to the scanner, =
she=20
  appeared drowsy. (epidual hematom, contusion bleedning&nbsp; contra=20
  coup,</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>scapula fracture, 3 costa fractures =
on one=20
  side&nbsp;with accompanying small pleural hematoma/bleedning, 2 on the =
other=20
  side,&nbsp;and a probably old but serious compresion fracture of=20
  TH12).</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2>Regards&nbsp;&nbsp; Mike =
H</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <BLOCKQUOTE dir=3Dltr=20
  style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
    <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
    <DIV=20
    style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
    <A title=3Dkarim@trauma.org href=3D"mailto:karim@trauma.org">Karim =
Brohi</A>=20
    </DIV>
    <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
    href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
    <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Saturday, March 29, =
2003 10:56=20
    PM</DIV>
    <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: Renal injury - =
Part=20
    1r</DIV>
    <DIV><BR></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff =
size=3D2>Not quite=20
    Andrew</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff=20
    size=3D2></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff =
size=3D2>Patient=20
    arrives</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff=20
    size=3D2>Haemodynamically unstable - do FAST</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff=20
    size=3D2>Haemodynamically stable - observe / examine / =
CT</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff=20
    size=3D2></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff =
size=3D2>FAST does not=20
    help decision making in haemodynamically stable blunt abdominal=20
    trauma.</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff =
size=3D2>FAST positive=20
    -&gt; CT.&nbsp; FAST negative -&gt; CT.</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff =
size=3D2>Good practice=20
    though.</FONT></SPAN></DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff=20
    size=3D2></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D201395120-29032003><FONT color=3D#0000ff=20
    size=3D2>Karim</FONT></SPAN></DIV>
    <BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
      <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
      size=3D2>-----Original Message-----<BR><B>From:</B> <A=20
      =
href=3D"mailto:trauma-list-admin@trauma.org">trauma-list-admin@trauma.org=
</A>=20
      [mailto:trauma-list-admin@trauma.org]<B>On Behalf Of </B>Andrew J=20
      Bowman<BR><B>Sent:</B> 29 March 2003 18:48<BR><B>To:</B>=20
      trauma-list@trauma.org<BR><B>Subject:</B> Re: Renal injury - Part=20
      1r<BR><BR></FONT></DIV>
      <DIV><STRONG><FONT face=3DTahoma size=3D2>Patient arrives, do =
FAST, find=20
      fluid.&nbsp; Patient is stable do CT, find injury, next step based =
on=20
      injury and stability.</FONT></STRONG></DIV>
      <DIV><STRONG><FONT face=3DTahoma =
size=3D2></FONT></STRONG>&nbsp;</DIV>
      <DIV><STRONG><FONT face=3DTahoma =
size=3D2>AJB</FONT></STRONG></DIV>
      <BLOCKQUOTE dir=3Dltr=20
      style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
        <DIV style=3D"FONT: 10pt arial">----- Original Message ----- =
</DIV>
        <DIV=20
        style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
        <A title=3Dhey@dadlnet.dk =
href=3D"mailto:hey@dadlnet.dk">hey@dadlnet.dk</A>=20
        </DIV>
        <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
        =
href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> </DIV>
        <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Saturday, March 29, =
2003 9:41=20
        AM</DIV>
        <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: Renal injury =
- Part=20
        1r</DIV>
        <DIV><BR></DIV>
        <DIV><FONT face=3DArial>Doc Rick</FONT></DIV>
        <DIV><FONT face=3DArial>I am curious. I scan, and find fluid. =
The patient=20
        is stable. what now?</FONT></DIV>
        <DIV><FONT face=3DArial>Mike=20
</FONT></DIV></BLOCKQUOTE></BLOCKQUOTE></BLOCKQUOTE></BLOCKQUOTE></BODY><=
/HTML>

------=_NextPart_000_0000_01C2FABD.3D069640--