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Change of subject; Penetrating trauma to extremity

Roy Danks roydanks at hotmail.com
Wed Apr 19 16:04:54 BST 2006


Rick,

EAST has published guidelines for these.  I generally follow them, but will deviate as needed.

This is how I handle them:

1)  Physical exam: 
       Wound:  Any signs of expanding hematoma or pulsatile mass?  If so, go to OR
       Distal vascular:  Palpable pulses?  If so, quality?  Will Dopplar at times.  If good pulses and wound is stable, will get ABIs.  If ABI shows impaired flow and pt is stable, I prefer standard angiography.  CT angio is not the standard as yet...don't let your on-call night radiologist tell you CTA is the same.  

However, there is some evidence:  JOT, March 2006, to suggest multi-slice CTA is good enough.  It's retrospective and majority were GSWs (as expected in most centers).  Only 3% were SWs.

If I operate on the artery, I prefer a standard angio for roadmap.  That's just me.

Hope this helps.  Question:  Dr. Mattox, are you out there?  This is right up your alley.  Would be interested to hear your opin.

RD

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