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Fri Jul 9 12:47:46 BST 2004

Our decision to obtain the MRA was to better elucidate that there was no 
flow in the vessel, as the management would have been different if there 
was ZERO flow vs. Minimal flow. We too were concerned about the risk of a 
posterior circulation stroke in this situation. Also, in view of the 
fracture and verterbral injury, we also wanted to ensure that the other 
vessels were not injured (dissection, etc), so i hardly think these were 
"unnecessary tests" to qualify for your VOMIT syndrome. 
The only thing that makes me VOMIT, is your unwillingness to have a 
Socratic discussion about the topic to help educate us about the topic you 
apparently know everything about, when after i took a poll of well 
respected neurosurgeons, neuroradiologists, vascular surgeons and trauma 
surgeons, they were challenged to know the "best practice" for this 
specific injury. So if YOU have some evidence based practice relating to 
this injury, please share it with all of us, as my review of recent 
literature did not demonstrate a consistent recommendation, thus leaving 
care of this patient to our best judgment....but gee, perhaps that's why i 
brought it to this list in the first place.....hopefully others will weigh 
in on this case with more than just a cursory insult and dismissal....
jcw

DocRickFry at aol.com
Sent by: trauma-list-bounces at trauma.org
07/08/2004 05:36 PM
Please respond to Trauma & Critical Care mailing list

        To:     trauma-list at trauma.org (Trauma & Critical Care mailing list)
        cc: 
        Subject:        Re: Case advice: Verterbral artery injury

In a message dated 7/8/2004 12:59:33 PM Eastern Daylight Time, 
KMATTOX at aol.com writes:

> 
>In a message dated 7/8/2004 10:34:49 AM Central Standard Time,  
>JonWalsh at Borgess.com writes:
>
>What next? 
>Coil  the L vertebral? 
>Anticoagulate the  patient? 
>Leave him alone?  
>Any radiographic followup  necessary?
>
>
>Coil both below and above the lesion.  Get into the distal portion  from 
the 
>other vertebral.  WIthout this therapy you risk a posterior  circulation 
>stroke.  
> 
>k
>Of course I read this just after posting my "leave alone" answer--and Dr 
Mattox, with all due respect, you cannot justify such intervention, or 
imposing such risk and cost, with any level of evidence beyond case 
reports or small case series of "that's what I do because it makes sense 
to me, and as a surgeon I just cannot stand to keep my hands off of any 
shadow on a piece of celluloid" caliber.  Do your own principles not apply 
here?
ERF
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Case advice: Verterbral artery injury