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Wed Aug 11 06:05:05 BST 2004

I would have given the patient 2 aspirin and have him call me in the
morning.

CHRIS M. BOYER
Emergency Medicine Consultant
Hayman Daugherty Associates
5105 Old Ellis Pointe
Roswell, GA 30076
(o) 800-765-0432 x 16
(f) 800-782-4999
(c)770-587-4997
Email: cboyer at haymandaugherty.com
Website: www.haymandaugherty.com

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-----Original Message-----
From: ARUNI SEN [mailto:ARUNI.SEN at new-tr.wales.nhs.uk]
Sent: Tuesday, August 10, 2004 2:31 PM
To: Trauma & Critical Care mailing list
Subject: RE: fluids ad naseum...sorry sometimes the surgeon is the
problem

CRUSH injury is where fluids are NEEDED - despite the being unpopular!

Aruni Sen
MS FRCS FFAEM
Consultant in Emergency Medicine
Wrexham Maelor Hospital; North East Wales NHS Trust
Wrexham LL13 7TD, UK.
Tel 01978 725555 / 725498 (secy)
Fax 01978 725168
Mobile 07931 542759 ; Pager 07625 618656
Email : aruni.sen at new-tr.wales.nhs.uk

	-----Original Message-----
	From:	John Holmes [SMTP:docjohnholmes at hotmail.com]
	Sent:	Tuesday, August 10, 2004 4:29 AM
	To:	trauma-list at trauma.org
	Subject:	RE: fluids ad naseum...sorry sometimes the surgeon is the problem

	Certainly would not have taken him to CT (the tunnel of death) at this
point
	as he is still haemodynamically unstable.   Nothing is obvious on plain
	films so if the patient remains unstable following judiicious fluids then
	surgeons need to decide if laparotomy is indicated despite negative FAST.
	Though 3rd space fluid losses could be significant, you would expect them
to
	be self limiting.  Also look for occult injuries elswhere - do repeated
	clinical evaluations of chest, abdo and limbs.  Would also worry about
	rhabdo - watch serum bicarb, urinary myoglobin - consider giving IV
	bicarbonate.

	John

	>From: joe.nemeth at staff.mcgill.ca
	>Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
	>To: trauma-list at trauma.org
	>Subject: fluids ad naseum...sorry sometimes the surgeon is the problem
	>Date: Mon,  9 Aug 2004 22:00:56 -0400
	>
	>
	>25 male
	>fell off of truck... bilateral crush injuries to thighs
	>
	>1-received 1 liter cryst. pre-hosp...
	>
	>on arrival :P:140...BP:80/-...GCS 14 )
	>
	>swollen, not tense, echymotic thighs... Femur XR:neg
	>
	>2-CXR/PELVIS/FAST neg
	>
	>-trauma team (seperate entity from the ED doc) wants to take him to CT for
	>?Dg
	>of shock NYD but..."unstable"
	>
	>3-given 1.5 liters of crystalloids (to my opposition)...P:110...BP 110/-
	>"now
	>he is stable" will take CT abd.: neg
	>
	>question: what would you have done at point 3...?
	>
	>
	>JNemeth
	>Emergency Medicine
	>McGill University
	>
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Mae'r e-bost hwn ac unrhyw ffeiliau a drosglwyddir gydag ef yn
gyfrinachol ac wedi'u bwriadu ar gyfer pwy bynnag y cyfeirir ef ato neu
atynt.  Os ydych wedi ei dderbyn drwy gamgymeriad yna gadewch i'r
rheolwr systemau wybod drwy ddefnyddio'r manylion isod.

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fluids ad naseum...sorry sometimes the surgeon is the problem