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Tue Nov 29 18:40:54 GMT 2005

Mathias,

Actually I was not the resident taking care of the patient. The point you
are making, that the patient was "too hypotensive" for an isolated femur
fracture, was also made by our surgeons here. Well, I can´t find other
explanation for the initial marked hypotension than the huge femoral
hematoma, and that is why I think arteriography should have been done on
arrival, wich wasn´t. After 24 hours, the patient went to OR for fasciotomy,
and a big haematoma was drained on the lateral aspect of the thigh. The
first days in ICU the patient was normotensive, becoming hypotensive again
because of sepsis, wich led to his death, 9 days after the accident.

Felix.

----- Original Message -----
From: "Mathias Kalkum" <listen at doc-kalkum.de>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, November 29, 2005 4:27 PM
Subject: Re: Fx Femur

> Felix,
>
> > - snip - Only identifiable injury was a fractured right femur (closed)
with important edema, with diminished but simetrical peripheral pulses,
consistent with the shock state (first inaudible, after ressuscitation
60/30). - snip -
>
> So you took care for this gentleman over several days, took him to the
> OR a few times and should have had ample opportunity to rule out ongoing
> signifcant bleeding as well as ischaemia caused by vascular injury.
>
> What do you think caused his death? What was your explanation for this
> unsusual low blood pressure? A 55 y/o with an *isolated* closed femur
> fracture *and without you giving us any severe medical history* should
> even with considerable bleeding in his thigh not show such remarkable
> low blood pressure.
>
> Mathias
> --
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Fx Femur