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trauma-list Digest, Vol 34, Issue 47

Maureen Kemner maureenkemner at sbcglobal.net
Wed Apr 26 06:47:17 BST 2006


Does anyone have a good trauma site that is dedicated to nursing?  We are trying to form a solid trauma nursing base and create resources for both experienced and new traume nurses.  Any help or info would be appreciated.
  Thanks, 
  Maureen

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Today's Topics:

1. Re: bloody rectum... (Ronald Gross)
2. RE: bloody rectum... (Ronald Gross)
3. Re: bloody rectum... (docrickfry at aol.com)
4. Re: bloody rectum... (Ronald Gross)
5. Powerpoint Summary from Ken's Trauma and Critical Care 2006
conference (Hardcastle Tim, Dr )
6. RE: bloody rectum... (Errington Thompson)
7. Re: nexus 2...Andrew! (Andrew J Bowman)
8. Re: nexus 2...Andrew! (Andrew J Bowman)
9. Re: bloody rectum... (docrickfry at aol.com)
10. Surgeons in the ED (bensonblues at comcast.net)
11. Trauma & Criticalcare Surgery 2006 (KMATTOX at aol.com)
From: "Ronald Gross" <Rgross at harthosp.org>
Subject: Re: bloody rectum...
Date: Tue, 25 Apr 2006 07:53:09 -0400
To: <trauma-list at trauma.org>

Rick, would you do an EUA first, or simply watch?

>>> 04/24 2:58 PM >>>
Watch NPO overnite, fed the next day if no change in abdominal exam,
send home when eating
ERF 

-----Original Message-----
From: joe.nemeth at staff.mcgill.ca 
To: trauma-list at trauma.org 
Sent: Mon, 24 Apr 2006 07:56:40 -0400
Subject: bloody rectum...


once again: 

-30 y.o.female 
-straddle injury, picket fence 
-sustains "deep" perianal lac. 
-DRE: good tone, no blood 
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered
DRE exam") 
-fleet enema 
-repeat sig: same 
-CT with rectal contrast: neg. 

what next?... 

-- Dr. Joe Nemeth 
Assistant Professor 
Emergency Medicine 
Montreal General Hospital 
Montreal Children's Hospital 
McGill University Health Center 


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From: "Ronald Gross" <Rgross at harthosp.org>
Subject: RE: bloody rectum...
Date: Tue, 25 Apr 2006 08:00:42 -0400
To: <trauma-list at trauma.org>

Doug,
After I sent that post I KNEW that I had misrepresented my thought
process..... I would consider one at any age, if it were necessary to
ensure wound healing. In this case I was thinking (in my own mind) that
she most likely would be well-nourished, and capable of maintaining a
clean wound without soilage when moving her bowels.

Thanks for making me clarify ;-)

Ron

>>> "Geehan, Douglas" 04/24 9:15 PM >>>
Ron,

At what age would you consider a diverting colostomy???

Regards,

Doug

Douglas Geehan, M.D.
Associate Professor
Department of Surgery
University of Missouri-Kansas City
geehand at umkc.edu 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Ronald Gross
Sent: Mon 4/24/2006 8:24 AM
To: trauma-list at trauma.org 
Subject: Re: bloody rectum...



EUA to be able to 1. examine extend of "perianal" (vs prineal) wound
and
2. do a very thorough and slow rigid sig with ability to insufflate,
wipe and observe. BaE of no real use here as I see it, and I woudl
suspect that CT with rectal contrast will be of little help as well.
Assuming no other injuries, drain/pack wound, with diligent wound
care.
Given patient's age, one would hope to avoid diverting
colostomy.......
Do you have any photos of the actual wound? That would help here.

Take care,
Ron

>>> joe.nemeth at staff.mcgill.ca 04/24 7:56 AM >>>
once again:

-30 y.o.female
-straddle injury, picket fence
-sustains "deep" perianal lac.
-DRE: good tone, no blood
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered

DRE exam")
-fleet enema
-repeat sig: same
-CT with rectal contrast: neg.


what next?...


--
Dr. Joe Nemeth
Assistant Professor
Emergency Medicine
Montreal General Hospital
Montreal Children's Hospital
McGill University Health Center




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From: docrickfry at aol.com
Subject: Re: bloody rectum...
Date: Tue, 25 Apr 2006 09:16:17 -0400
To: trauma-list at trauma.org

The post said a scope was done and nothing but some proximal blood found--would do an EUA if there was some dissatisfaction with the scope 
ERF
-----Original Message-----
From: Ronald Gross 
To: trauma-list at trauma.org
Sent: Tue, 25 Apr 2006 07:53:09 -0400
Subject: Re: bloody rectum...


Rick, would you do an EUA first, or simply watch?

>>> 04/24 2:58 PM >>>
Watch NPO overnite, fed the next day if no change in abdominal exam,
send home when eating
ERF 

-----Original Message-----
From: joe.nemeth at staff.mcgill.ca 
To: trauma-list at trauma.org 
Sent: Mon, 24 Apr 2006 07:56:40 -0400
Subject: bloody rectum...


once again: 

-30 y.o.female 
-straddle injury, picket fence 
-sustains "deep" perianal lac. 
-DRE: good tone, no blood 
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered
DRE exam") 
-fleet enema 
-repeat sig: same 
-CT with rectal contrast: neg. 

what next?... 

-- Dr. Joe Nemeth 
Assistant Professor 
Emergency Medicine 
Montreal General Hospital 
Montreal Children's Hospital 
McGill University Health Center 


-- 
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From: "Ronald Gross" <Rgross at harthosp.org>
Subject: Re: bloody rectum...
Date: Tue, 25 Apr 2006 09:33:50 -0400
To: <trauma-list at trauma.org>

I sorta got the drift that there was......thanks.

>>> 04/25 9:16 AM >>>
The post said a scope was done and nothing but some proximal blood
found--would do an EUA if there was some dissatisfaction with the scope

ERF
-----Original Message-----
From: Ronald Gross 
To: trauma-list at trauma.org 
Sent: Tue, 25 Apr 2006 07:53:09 -0400
Subject: Re: bloody rectum...


Rick, would you do an EUA first, or simply watch?

>>> 04/24 2:58 PM >>>
Watch NPO overnite, fed the next day if no change in abdominal exam,
send home when eating
ERF 

-----Original Message-----
From: joe.nemeth at staff.mcgill.ca 
To: trauma-list at trauma.org 
Sent: Mon, 24 Apr 2006 07:56:40 -0400
Subject: bloody rectum...


once again: 

-30 y.o.female 
-straddle injury, picket fence 
-sustains "deep" perianal lac. 
-DRE: good tone, no blood 
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered
DRE exam") 
-fleet enema 
-repeat sig: same 
-CT with rectal contrast: neg. 

what next?... 

-- Dr. Joe Nemeth 
Assistant Professor 
Emergency Medicine 
Montreal General Hospital 
Montreal Children's Hospital 
McGill University Health Center 


-- 
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From: "Hardcastle Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
Subject: Powerpoint Summary from Ken's Trauma and Critical Care 2006 conference
Date: Tue, 25 Apr 2006 16:50:17 +0200
To: "Trauma-List (E-mail)" <trauma-list at trauma.org>

Hi everyone

I have been "off-list" for the past two weeks (student exams and so on!) and was wondering if Ken had posted any more of the short powerpoints of his recent conference. I have only seen the first one as yet.

If I have missed any of them please could I ask if, maybe Ken forward them directly to me.

Thanks for the first one - was great!
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



From: "Errington Thompson" <errington at erringtonthompson.com>
Subject: RE: bloody rectum...
Date: Tue, 25 Apr 2006 11:26:30 -0400
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>

I don't understand the term "watch" or "observe". What are you "watching"
for? Increase in WBC, fever, abdominal tenderness? 

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.erringtonthompson.com

 
Everyone deserves to make an informed decision
                                - Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Tuesday, April 25, 2006 7:53 AM
To: trauma-list at trauma.org
Subject: Re: bloody rectum...

Rick, would you do an EUA first, or simply watch?

>>> 04/24 2:58 PM >>>
Watch NPO overnite, fed the next day if no change in abdominal exam,
send home when eating
ERF 

-----Original Message-----
From: joe.nemeth at staff.mcgill.ca 
To: trauma-list at trauma.org 
Sent: Mon, 24 Apr 2006 07:56:40 -0400
Subject: bloody rectum...


once again: 

-30 y.o.female 
-straddle injury, picket fence 
-sustains "deep" perianal lac. 
-DRE: good tone, no blood 
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered
DRE exam") 
-fleet enema 
-repeat sig: same 
-CT with rectal contrast: neg. 

what next?... 

-- Dr. Joe Nemeth 
Assistant Professor 
Emergency Medicine 
Montreal General Hospital 
Montreal Children's Hospital 
McGill University Health Center 


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From: "Andrew J Bowman" <sumieb at compuserve.com>
Subject: Re: nexus 2...Andrew!
Date: Tue, 25 Apr 2006 11:44:41 -0400
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

I could not find it in that journal, are you sure it was there?

There was an article about biomarkers for brain injury but I was looking for
CT in minor TBI which I thought was the crux of NEXUS 2

Andrew

----- Original Message ----- 
From: 
To: 
Sent: Friday, April 21, 2006 11:42 PM
Subject: nexus 2...Andrew!


>
> Andrew,
>
> here it is...
>
> needs to be validated of course...
>
> PEDIATRICS Vol. 117 No. 2 February 2006, -- Dr. Joe Nemeth
> Assistant Professor
> Emergency Medicine
> Montreal General Hospital
> Montreal Children's Hospital
> McGill University Health Center
>
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>



From: "Andrew J Bowman" <sumieb at compuserve.com>
Subject: Re: nexus 2...Andrew!
Date: Tue, 25 Apr 2006 11:55:20 -0400
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>

oops, I found it, I was looking at the wrong version of the journal.

Andrew

----- Original Message ----- 
From: 
To: 
Sent: Friday, April 21, 2006 11:42 PM
Subject: nexus 2...Andrew!


> 
> Andrew,
> 
> here it is...
> 
> needs to be validated of course...
> 
> PEDIATRICS Vol. 117 No. 2 February 2006, -- Dr. Joe Nemeth
> Assistant Professor
> Emergency Medicine
> Montreal General Hospital
> Montreal Children's Hospital
> McGill University Health Center
> 
> 
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> 


From: docrickfry at aol.com
Subject: Re: bloody rectum...
Date: Tue, 25 Apr 2006 12:10:30 -0400
To: trauma-list at trauma.org

Correct--same things you watch for as well whenever you nonoperatively observe a trauma patient for whatever reason--i.e. for free fluid on CT with no solid organ injury and benign exam, multiple injuries with benign abdomen being admitted for serial exams, etc.
ERF 

-----Original Message-----
From: Errington Thompson 
To: 'Trauma & Critical Care mailing list' 
Sent: Tue, 25 Apr 2006 11:26:30 -0400
Subject: RE: bloody rectum...


I don't understand the term "watch" or "observe". What are you "watching"
for? Increase in WBC, fever, abdominal tenderness? 

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.erringtonthompson.com


Everyone deserves to make an informed decision
- Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Tuesday, April 25, 2006 7:53 AM
To: trauma-list at trauma.org
Subject: Re: bloody rectum...

Rick, would you do an EUA first, or simply watch?

>>> 04/24 2:58 PM >>>
Watch NPO overnite, fed the next day if no change in abdominal exam,
send home when eating
ERF 

-----Original Message-----
From: joe.nemeth at staff.mcgill.ca 
To: trauma-list at trauma.org 
Sent: Mon, 24 Apr 2006 07:56:40 -0400
Subject: bloody rectum...


once again: 

-30 y.o.female 
-straddle injury, picket fence 
-sustains "deep" perianal lac. 
-DRE: good tone, no blood 
-rig. sig.:fresh blood distal rectum ("?maybe ED doc's bloody fingered
DRE exam") 
-fleet enema 
-repeat sig: same 
-CT with rectal contrast: neg. 

what next?... 

-- Dr. Joe Nemeth 
Assistant Professor 
Emergency Medicine 
Montreal General Hospital 
Montreal Children's Hospital 
McGill University Health Center 


-- 
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From: bensonblues at comcast.net
Subject: Surgeons in the ED
Date: Tue, 25 Apr 2006 18:54:56 +0000
To: trauma-list at trauma.org

Ann Emerg Med. 2006 Feb;47(2):135. Epub 2006 Jan 4.Related Articles, Links



Clinical decision rules for secondary trauma triage: predictors of emergency operative management.
Steele R, Green SM, Gill M, Coba V, Oh B.
Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA. SteeleMD at sbcglobal.net
STUDY OBJECTIVE: Most injured patients taken by ambulance to hospital emergency departments do not require emergency surgery, yet most US trauma centers require a surgeon to be present on their arrival. If a clinical decision rule could be developed to accurately identify which injured patients require emergency operative intervention, then such "secondary triage" criteria could permit a trauma center to more efficiently use their surgeons' time. METHODS: We analyzed 7.5 years of data (8,289 consecutive trauma activations) in our prospectively maintained Level I trauma center registry. We used classification and regression tree analyses to generate clinical decision rules using standard out-of-hospital variables to identify emergency operative intervention (within 1 hour) by a general surgeon (for adults) or a pediatric surgeon (if < or =14 years). RESULTS: Emergency operative intervention occurred in 3.0% of adults and 0.35% of children. For adults, summoning a surgeon for
 a
ny one
of 3 criteria (penetrating mechanism, systolic blood pressure <96 mm Hg, pulse rate >104 beats/min) could reduce surgeon calls by 51.2% while failing to identify emergency operative intervention in only 0.08% (rule sensitivity 97.2% and specificity 48.6%). For children, no rule at all (ie, never automatically summoning a surgeon) would fail to identify emergency operative intervention in only 0.35% of patients, and use of a single criterion (penetrating mechanism) would reduce surgeon calls by 96.2% while failing to identify emergency operative intervention in only 0.09% (rule sensitivity 75.0% and specificity 96.5%). CONCLUSION: We have derived simple decision rules for trauma centers that, if validated, could substantially reduce the need for routine surgeon presence on trauma patient arrival. These rules demonstrate low false-negative rates
From: KMATTOX at aol.com
Subject: Trauma & Criticalcare Surgery 2006
Date: Tue, 25 Apr 2006 19:27:27 EDT
To: trauma-list at trauma.org

Attached is the third in a long series. I am going to be out of my office 
for a couple of a weeks or more...... so delay in next one.....

On another note. We just went through our 7th Level I trauma Center 
Verification visit. The surgeons and nurses have some very valuable suggestions to 
those who might be undergoing verification visits in the future. The 
process has improved remarkably since the earliest days of this program, way back 
in the early 1980s. 

k
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