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Mon Aug 28 02:14:13 BST 2006

In a message dated 8/27/2006 7:22:52 P.M. Central Standard Time,  
shebrain1 at yahoo.com writes:

and Left  lower lung with laceration almost cutting it in tow parts, with 
active venous  bleed and air leak.pericardiotomy was made, internal cardiac 
message was  initiated, lung twisted, pt developed V-fib, and multiple air bubbles 
in  coronaries, with no recovery.
1.5 cm laceration at inferior  vena-cava-Rt atrium junction was found.
What things that could be  done differently??
--

You did a great job and your logic and decision tree was superb.   PERIOD.  
You had NO indication to do other than you did .     With a NEGATIVE FAST for 
hemopericardium you were not bound to go into  chest.    You might have cut 
diaphragmnantic surface of  pericardium from the abdomen, but it would have then 
have been a  nightmare.   The ONLY thing I would have done differently would 
have  to PROHIBITED the anesthesiologist from using pressors.    

Lacerations at the atrium IVC junction have a mortality of greater than  80%. 
 Do not let anyone tell you differently.  This was a fatal injury  and this 
patient had the best that your city and system had to  offer.   Be Proud that 
you are a member of this acute care surgery,  surgical critical care, trauma 
surgery GUILD,    Most suregeons  in the world would not have gotten as far as 
did you and your team.    Take them out to dinner for a job well done.    

BUT be ready for the next tough case.

k

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