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Mon Aug 28 14:40:17 BST 2006

Dear Saad, 

Nothing should have been done differently. The injury was not compatible
with life. 

With only 400 ml coming out of chest tube, going for the abdomen is
obvious and correct. 

Avi

 On Sun, 27 
Aug 2006, saad shebrain wrote:

> FAST was positive only for Fluid in abdomen,
>   went to abdomen, at least 2 L of hemoperitoneum, grade 4 splenic
> laceration (splenectomy was done quickly)  with active bleeding, grade
> 3 liver inj (Packed with 101 technique). No central or retroperitoneal
> hematoma.
>   Anesthesia inserted Rt IJ and stated using it for resuscitation.
>   shortly within 20 min CT out put increased to 1200 .(from 400
> initial)with indication that hemothorax is increasing by ispecting
> diaphragmatic movement and pt developed hypotension.  and now pt on
> pressors and anesthesia trying to catch up.
>   Thoracotomy with clamshell extension was made, massive hemothorax.
> with findings of tense pericardium 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??
> --
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel

email:avir at bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390

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