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Sat Aug 7 11:37:56 BST 2004

I'll support you Karim, because I have seen it done in similar circumstances
with a good outcome.

S

Stephen Hines
BSc (Hons), Dip IMC RCS (Ed),
Paramedic Training Officer
London, UK
www.londonambulance.nhs.uk
http://stephenhines.moonfruit.com/
----- Original Message ----- 
From: "Karim Brohi" <karim at trauma.org>
To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Friday, August 06, 2004 7:54 PM
Subject: RE:ED Thoracotomy for pulseless penetrating abdominal trauma

Would you ever do this then?  How do you get the pulseless patient to the
OR?  IV fluids ???? ED laparotomy????  Or do you pronouce these patients in
the ED (ie. PEA with narrow-complexes not agonal, no palpable pulse,
penetrating abdominal injury).

If noone speaks up in favour of ED thoracotomy in this situation I'll
re-work the pages.  At the moment it is listed as an option to consider -
should it never be done?

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of DocRickFry at aol.com
Sent: 06 August 2004 06:29
To: Trauma & Critical Care mailing list
Subject: RE: Penetrating Abdominal Trauma - help with images

Karim--
I agtree with Ron--as to your anecdotal case, here is the classic flaw of
such anecdotes--the likelihood is the ED thoracotomy was not the saving
factor--quick trip to the OR probably could have done the same thing.
Also--do you really think that cross-clamping the THORACIC aorta did
anything whatsoever to stem bleeding from the IVC and renal vein???? Think
about the unlikelihood of that.  In fact, venous bleeding is low pressure,
and stops fairly readily from the retroperitoneal tamponade effect, and with
low blood pressure hold itelf quite well.  So the patient may hve lived
after having had an ED thoracotomy, but do not confuse that with having
needed it--only delayed the necessary treatment.  My description would be
that he lived DESPITE the ED thoracotomy ERF
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ED Thoracotomy for pulseless penetrating abdominal trauma