GUNSHOT WOUND THROUGH BOTH THIGHS

• Previous message: NEW TOPIC - SCI TRANSFERS
• Next message: GUNSHOT WOUND THROUGH BOTH THIGHS
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

 
Tim
do you mean abnormal pulse or absent pulse. 
 
my approach to such injuries is so different from the respondents.
 
Has anyone seen the angiogram i posted?
 
sal
 
 
 
In a message dated 1/31/2005 5:29:11 A.M. Eastern Standard Time,  
tch at sun.ac.za writes:

Sal

Single penetration to the thigh with a thru-thru wound and  abnormal pulses 
mandates exploration, not angiography! If the pulses return to  normal and 
there is no evidence of hard signs then I don't see why you need to  do anything 
more - I would keep overnight NOT FOR VASCULAR reason, but to  ensure that 
there is no developing compartment syndrome, secondary to muscle  oedema, as 
result of primary muscle swelling, we've seen this occationally!  Most likely that 
there was acute spasm from the so-called "cavitation" (does  this really 
exist???). If there are no bruits then send him home / to jail on  the morrow!

Regards
Tim H
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-----
23 year old man sustained one  gunshot wound during interaction with NYPD.  
Patient presented with a  gunshot that penetrated the left suprapatellar area 
 
from left to  right then entered and exited the right thigh. On admission he 
was   
hemodynamically stable. Initial physical exam revealed a black male with  in 
and  out holes in each thigh. There were no hematomas, no history  of major 
bleed at  the scene and slightly diminished pulses in the  right foot. When 
the 
trauma  resident examined the patient shortly  thereafter, pulses were 
markedly  
diminished to absent. A few minutes  later the attending assessment was that 
the 
pulses were dminished but  present.
An arteriogram was requested and set up. By the time the team was  ready to  
begin the angio, the pulses were totally  normal.

Would you do an arteriogram on this patient with normal  pulses?
Do you rely on ABI to screen for vascular  injury
--
trauma-list : TRAUMA.ORG
To change your settings or  unsubscribe  visit:
http://www.trauma.org/traumalist.html


 

• Previous message: NEW TOPIC - SCI TRANSFERS
• Next message: GUNSHOT WOUND THROUGH BOTH THIGHS
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]