List Archives

Fri Dec 22 05:02:59 GMT 2006

Dean

As a fellow SA dr. I would not operate if the CT head showed non-survivable injury in the context of a patient stable enough to have gone to scanner first. The critique may have been that the surgeon should first do the laparotomy - i.e. address a,b & C, then sort out the head (CT later); this would certainly hold water if the patient was UNstable. Then the justification is simply that the potential for hypoperfusion as the contributor to the low GCS is excluded. 

Your term "brain dead" here needs qualification - have you done all the tests yet? Or is he just a GCS 3 from scene - I've seen these WAKE-UP!

Regards
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
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
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

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Dean Lutrin
Sent: Thursday, December 21, 2006 7:12 PM
To: 'Trauma & Critical Care mailing list'
Subject: Brain dead and bleeding

Dear list

A quick question. What are your feelings on operating on a patient who comes
into your ER brain dead with intraabdominal bleeding? Do you treat the
abdomen on its own merits assuming that some of the low GCS may be
attributable to hypovolaemia etc...

I am of course assuming that the patient has been intubated without drugs,
there is no drug history etc etc...

We debated this a bit today where one of the surgeons did not operate on a
case because the CT brain showed unsurvivable injuries and was roundly
criticised.

Is this a matter of opinion or are there good answers?

Thanks 

Dean Lutrin
JHB, SA

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

List Archives

For your convenience, find the Trauma List Archive Below

Brain dead and bleeding