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penetrating vascular trauma: bleeding subclavian avf

Ronald Gross Rgross at harthosp.org
Sun Apr 23 15:22:47 BST 2006

As I told say earlier - I thought this was an excellent "deviation", and
would ask he did the same for me.


>>> SJASMD at aol.com 04/23 9:47 AM >>>
Tried to send this with an image but no one ever commented. I spoke  to
gross who said it never was received by the message board, although i
got  it
i was surprised by lack of comments so I will send the post again but 
rather than embed the image.
In a message dated 4/19/2006 11:07:47 A.M. Eastern Standard Time,  
roydanks at hotmail.com writes:

EAST has  published guidelines for these.  I generally follow them, but
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

I had a recent interesting "deviation" from that recommendation
28 year old male sustained stab wound of the left shoulder. on
hypotensive but responded with volume with improved pulses but bleeding
from the  
wound which was  managed by pressure.
take a deep breath, trauma surgeons.....
patient brought to angio with manual pressure applied. attached angio 
a subclavian arteriovenous fistula. This was treated by stent graft
controlled the bleeding and repaired the vessel in about forty 
he was discharged on fourth hospital day. Followup angio at five  weeks

showed good flow and equal upper extremity blood  pressures.
 i see more of this happening in the future


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