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Wed Nov 29 04:48:26 GMT 2006

Ian

If unstable and going to OR harpoon the chest - you risk decompensation on the table.

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 Ian Seppelt
Sent: Wednesday, November 29, 2006 1:50 AM
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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