List Archives

Tue, 17 Jun 2003 00:32:33 EDT

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Has anyone really looked at the patient from a physical examination 
standpoint well.  I have a hard time believing diastolic sounds at times; consider 1. 
Anesthesia 2. TEE interrogation of the heart and great vessels and of course 
the Ao valve; should be able to define tears. If you have a normal angio I am 
not sure even the TEE has to be done; while he is asleep place an arterial line 
and NOW you will have accurate SD BP. Then FIX his fractures while he is 
asleep... He will do a great deal better..clots will become stable at his fracture 
sites and if he does develop CHF and need of valve he will not bleed from the 
fracture sites as these will be stable.  This guy does not need IV hyperal but 
enteral nutrition in my opinion.  How is his colloid osmotic pressure? I have 
seen cases where low COPs lead to a murmur and a more rapid "run-off" and a 
lower than N diastolic as compared to systolic. Any possibility here?   FIX HIM 
AND FEED HIM, THEN MOVE HIM AND KEEP HIS COP 17-19   

Dennis T. (Tim) Crowe, Jr., DVM, DACVS, DACVECC, NREMT-II PI, CFF
Veterinary Surgery and Emergency - Critical Care Consulting
2621 Simons Court, Carson City, Nevada 89703
phone and fax 775-841-6821  crowehome@aol.com
Clinical Associate Professor, The Institute of Critical Care Medicine
1695 N Sunrise Way, Palm Springs, CA 92262   760-788-4911 

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<HTML>Has anyone really looked=20=
at the patient from a physical examination standpoint well.&nbsp; I have=20=
a hard time believing diastolic sounds at times; consider 1. Anesthesia 2. T=
EE interrogation of the heart and great vessels and of course the Ao valve;=20=
should be able to define tears. If you have a normal angio I am not sure eve=
n the TEE has to be done; while he is asleep place an arterial line and NOW=20=
you will have accurate SD BP. Then FIX his fractures while he is asleep... H=
e will do a great deal better..clots will become stable at his fracture site=
s and if he does develop CHF and need of valve he will not bleed from the fr=
acture sites as these will be stable.&nbsp; This guy does not need IV hypera=
l but enteral nutrition in my opinion.&nbsp; How is his colloid osmotic pres=
sure? I have seen cases where low COPs lead to a murmur and a more rapid "ru=
n-off" and a lower than N diastolic as compared to systolic. Any possibility=
 here?&nbsp;&nbsp; FIX HIM AND FEED HIM, THEN MOVE HIM AND KEEP HIS COP 17-1=
9&nbsp;&nbsp; 
 
Dennis T. (Tim) Crowe, Jr., DVM, DACVS, DACVECC, NREMT-II PI, CFF 
Veterinary Surgery and Emergency - Critical Care Consulting 
2621 Simons Court, Carson Ci=
ty, Nevada 89703 
phone and fax 775-841-6821&nbsp; crowehome@aol.com 
Clinical Associate Profes=
sor, The Institute of Critical Care Medicine 
1695 N Sunrise Way, Palm Spr=
ings, CA 92262&nbsp;&nbsp; 760-788-4911 </HTML>

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Wheelie @100 mph - Decision time -yes FIX, FEED, GET HIM MOVING