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Thu Jan 19 21:17:42 GMT 2006

I do not have exact numbers but in our experience at Marshall it ismuch higher. He will need very aggressive vent management to protect his lungs.  RW 

-----Original Message-----
From: robert wagner <rwag63 at yahoo.com>
To: Trauma &amp, Critical Care mailing list <trauma-list at trauma.org>
Sent: Thu, 19 Jan 2006 06:53:03 -0800 (PST)
Subject: Multisystem Trauma in the elderly

Recently had a case of a 62 yo wm on coumadin. Motorcycle single vehicle 
amnestic to the event. C/O L sided CP and mild dob.  CXR reveals L scapula 
fracture and pulm contusion with hemothorax. Sats 90-95%. Chest tube placed and 
intubated CT head, and abd negative. Initially hypotensive but resolves with 
blood and FFP

  Based on this case I have a question regarding morbidity and mortality in this 
particular age group. What is the morbidity and mortality of a pulmonary 
contusion in the age group 60 -65? Does it raise it being that he is on 
coumadin. Is he fubared or should he have a fairly good outcome?

  Thanks for your input

  Robert J. Wagner, M.D.
  rwag63 at yahoo.com

Paul.Harrison at sth.nhs.uk wrote:
  For UK practitioners, you may wish to note the medical consensus and position 
statement of the UK SCI Consultant body - The British Association of Spinal Cord 
Injury Specialists (www.bascis.pwp.blueyonder.co.uk.

Quote:
Highly publicised studies have suggested that high dose Methylprednisolone 
therapy is an essential treatment in most cases of spinal cord injury in spite 
of important related clinical complications. In common with clinicians in other 
countries BASCIS has carefully evaluated the information now available. The 
published evidence does not support the use of high dose Methylprednisolone as a 
standard treatment in acute spinal cord injury. 

Key point: Your local Spinal Injuries Centre will always be ready to give advice 
and provide support concerning any matter related to the management of patients 
with spinal injuries. Please do not hesitate to pick up the telephone to discuss 
your patient prior to referral and/or transfer to your Regional Spinal Injuries 
Centre.

Paul Harrison
Clinical Development Officer
Princess Royal Spinal Injuries Centre
Sheffield, UK

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Karim Brohi
Sent: 19 January 2006 01:31
To: 'Trauma & Critical Care mailing list'
Subject: ATLS 2nd printing modifies steroid in SCI guidelines

Well, looks like there has been a little shift in direction with the latest ATLS 
printing - and I'd like to think that the
trauma-list and Trauma.org had something to do with this.

There are now 69 signatories to our open letter to the COT
(http://beta.trauma.org/traumawiki/index.php?title=Steroids_for_SCI_open_letter)

Sign up if you haven't already (if you believe the evidence as presented:)
http://beta.trauma.org/traumawiki/index.php?title=Steroids_in_spinal_cord_injury

Karim
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Multisystem Trauma in the elderly