Multiple stab wounds - Damage control surgery?

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> With Anna Lindh's case given the location of the wounds and the 
> quick escape of the assailant I would venture to say that he fits 
> the profile of an expert. 
>
I hope and pray that you are wrong in your assumption.  I will assue you have never been to NK in Stockholm...on a good day it is packed with people, has terrible acoustics (there was apparently little commotion until long afterwards), easy access to the Stockholm Central rail / subway / bus terminals and as in any big city people are by & large focused on themselves instead of having situational awareness.

This is compounded by the fact that "homeless" people are under some sort of reverse stealth where no one wants to see them and therefore they cease to exist.  The Perp just walked away and wasn't even looked at.

> The Trauma team had their hands full and did their best, but the 
> multiple damages caused by a knife in the hands of an expert is 
> hard to remedy .
>
Please, do not give this individual any "credit" for a professional education or skill set.  A little old lady can kill with a 4" knife if she gets one good hit.  According to the reports of witnesses the assailant whaled the hell out of this poor woman but no one saw a knife - only when blood began pooling around did they react.  I'll bet you a beer it was a psych patient.  In fact Pedro I'll bet you 2 "Stor Stark" served at your choice of Stockholm Pub (you pay airfare & lodging)

My best guess about the DCS is that the mesenteric vessels were so heavily involved that they had blood coming from exactly everywhere.  This was not made easier by the fact that, by the surgical teams own media release, the patient had recieved steady blood transfusions for the entire time.  DIC would make an untenable situation exponentially worse.

Scott "Monday morning QB" Millington 
     
Sgt Pedro Meza (Medic)   

Anders Sillen <anders_sillen at yahoo.se> wrote:
  > ...I would like to commend
  > the EMS & Trauma staff for performing exceptionally
  > well in initiating care for Anna Lindh - Sweden's
  > Foreign Minister. 

  I totally agree with Scott on this. However, one
  question has to be raised, no matter how sensitive it
  is - why the extended operation? The latest reports
  are talking about twelve hours operating time,
  possibly with a short break after eight hours. 

  The concept of damage control surgery, very well
  presented on trauma.org, teaches us that we should
  minimize time in the OR in the initial phase of trauma
  care. Instead, we should focus on quickly controlling
  haemorrhage and contamination and then quickly
  transfer the patient to the ICU for correction of
  hypothermia, coagulopathy and acidosis. When these
  deadly problems are dealt with, the patient should be
  brought back to the OR for definitive repair.

  No shadow should be cast over the team working on
  saving Sweden's foreign minister. They obviously
  worked very hard, and the Trauma unit at Karolinska
  Hospital in Stockholm is considered the best in
  Sweden. So the question is: 
  What kind of liver or abdominal vessel injury can
  cause haemorrhage so severe it can't be controlled
  even temporarily, e.g. by packing? 
  I am not a trauma surgeon, so I am asking out of
  curiosity. Since nobody except the surgeons actually
  involved knows the real extent of the injury, the
  question is of course hypothetical. Nonetheless, I
  think it would be interesting to hear some thoughts
  from fellow list subscribers.

  Sincerely,
  Anders Sillen



  =====

  ====================================== 
  Anders Sillen, MD 
  e-mail: anders_sillen at yahoo.se

  Thought for the day: 
  "When in doubt - cut it out"


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