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K said:

First, I  would NOT have gotten the confusing CT.    What did  the plane
chest
X-ray show?    Second,  was this patient on   drugs or alcohol?

Third.   I would do a FAST or  Transthoracic Echo and look  for a shunt or
hemopericardium

Fourth:   I would NOT have given  Magnesium ?    ??????  why

FIfth:   With this  mechanism of injury, what did the aortogram  show?   THis

patient could EASILLY have a major vascular injury in the  presence  of the
"normal vasculature" CT scan.  This could be another   VOMIT

Joe replied:

first: MSO4 is also morhine sulfate not just MgSO4

second: if echo is fine would not do much else but observe...what did the first
ECG show (on arrival)...if ventricular abnormalicy should continue more than 48
hours out I would argue that the patient needs further work-up..did troponins
continue to rise?

third: would have to agree with meredith on the fact that the NPV of a CT for
major vasc. injury is high enough to not pursue an aortogram for fear of its
inherent dangers as well as a VOMIT

Nemeth
Emergency medicine
McGill University

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