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Wed Aug 23 17:20:15 BST 2006

And every one said AMEN!  
--------------------------
Sent from my BlackBerry Wireless Handheld

-----Original Message-----
From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Wed Aug 23 12:18:15 2006
Subject: RE: Thoracic and Abdominal Trauma

Hot lights and cold steel. What on earth did your anesthesiologist think was
the cause of the low pH, DKA?

R. Smith, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of navin goyal
Sent: Wednesday, August 23, 2006 12:12 PM
To: trauma-list at trauma.org
Subject: Thoracic and Abdominal Trauma

A 35 yr old male came to our Trauma centre, 5 hrs after a road traffic
accident (referred from peripheral centre)in condition of shock , drowsy
state, with tachypnoea , feeble pulse, BP on lower side , and large bruise
mark on the left chest and abdomen.Air entry was decreased  on the left
lower chest Iand guarding and tenderness was present in the lt.
hypochondrium and epigastrium . Immediate intuabation and ventilation, Chest
tube drainage , Oxygen support , Intravenous Fluid was given . FAST showed
Moderate hemoperitoneum .After resuscitation ( 0.5 hr) patient showed
improvement , BP - 120/80 , Pulse -130/min. Decision for Laparotomy was
taken and ABG sent . ABG showed ph-6.8/ pco2- 57.5/ p02- 278.3/ HCO3- 7.5.
  My anaesthetist was shocked to see this and said to wait till his acidosis
improves and I as a Surgeon wanted to do laparotomy as quick as possible so
that he has least blood loss and we both gave long reason to justify
ourselves.

  What should be the ideal way to treat this patient?

  Dr Navin Goyal
  Trauma Fellow
  LTM Medical College, Sion
  Mumbai, INDIA

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