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Sun Jul 4 15:06:19 BST 2004

Karim

What we are doing currently witjh the 15 or more such cases in our unit today:
No free air on CXR (I know not very sensitive), and soft non-tender abdo:
4hrly serial exams by SAME observer, 4hrly T/BP/P/RR/urine output. After 24 hrs - test feed. If not signs after a further 3-4 hours they go home. Works well for us! Under 0,5% comeback rate.

We sometimes will explore a large wound, otherwise follow the above. We always laparotomy for free air, but may even observe omentum-only evisceration (under 40% positive Laparotomy rate)

Regards
Tim
Dr TC Hardcastle
M.B.Ch.B(Stell); ATLS(I), DSTC(I); M.Med(Surg)(Stell); FCS(SA)
General Surgeon (Sections Trauma / ICU)
Dept. General Surgery
University of Stellenbosch / Tygerberg Hospital
PO Box 19063, 7505
Operational Head: Diana, Princess of Wales Trauma Centre
Program Coordinator: Emergency Medicine
Intern Rotation Coordinator: Surgery

tch at sun.ac.za <mailto:tch at sun.ac.za> 
2 Lorient Close
Vredekloof
Brackenfell
7560, W. Cape
South Africa
Cell: +27824681615
Home: +27219813098
Work: +27219384911 pager 0302

-----Original Message-----
From: Karim Brohi [mailto:karim at trauma.org]
Sent: Sunday, July 04, 2004 2:25 AM
To: 'Trauma & Critical Care mailing list'
Subject: July 4th poll: Stabbed abdomen

In expectation & anticipation of the coming 4th July hijinx - and a normal
Saturday night everywhere else - here's a quick trauma-list poll:

How do you evaluate a stab wound to the anterior abdomen in a
haemodynamically stable, otherwise fit adult without peritonitis:

1. Clinical examination & serial observations
2. Local Wound Exploration
3. Diagnostic Peritoneal Lavage
4. Ultrasound
5. CT
6. Laparoscopy
7. Laparotomy

Or some combination of the above.  Justify your decision.
If you choose DPL - What is your threshold for operation?
If you choose CT - Single or multislice; oral, IV, or triple contrast?

How does your answer change if the patient is GCS 12 from alcohol?

Enjoy the holiday

Karim

"when everything is simple in the white and the black
You will never have to see the grey anymore
You will never have to be afraid..."

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July 4th poll: Stabbed abdomen