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Tue Nov 28 23:57:57 GMT 2006

I would NOT do a chest CT.  Simple chest X-ray.   

K

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-----Original Message-----
From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
Date: Wed, 29 Nov 2006 10:49:54 
To:<trauma-list at trauma.org>, <rsnpinheiro at yahoo.com.br>
Subject: Re: What would you do?

FAST in ED. If positive and unstable then laparotomy. If stable enough then a CT first (but beware the tunnel of death). I'm not concerned about the breath sounds AT PRESENT, but keep in the back of your head. Do NOT harpoon the chest if you find a small anterior pneumothorax on CT.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> rsnpinheiro at yahoo.com.br 29/11/2006 9:35am >>>
Hi I´m Rafael from Brazil, I received this pacient and I´d like to know what would you do in this case:

  Pacient, 24 years old, motorcycle´s accident victim with history of important alcohol ingest.
  A - clear
  B - trachea central. decreased breath sound in right base chest. Sat. O2 96-97%. no   emphysema subcutaneous.
  C - Pulse 85bpm, BP 80x40mmHg (after 1.5 liter of crystaloid fluid) No external haemorrhage
  D - GCS 14 (E4 - V4 - M6),  pupils equal and reactive, agitated
  E - complaining of abdominal pain and he has a diffuse rigid abdomen

  What would you do in this situation?? 

  Thank you 

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What would you do?