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For your convenience, find the Trauma List Archive Below

trauma-list Digest, Vol 41, Issue 33

John E. Sutton Jr. John.E.Sutton.Jr at Hitchcock.ORG
Wed Nov 29 22:58:51 GMT 2006 

Quoting "trauma-list-request at trauma.org" <trauma-list-request at trauma.org>:
The "regulators" were actually a single individual with "attitude" but 
administrative power. I live in New Hampshire with a legislative House 
representation of over 400 members for a population of approximately 1.3 
million people. You don't have to have data...just preserve the "live free or 
die" motto... as I like to say in my trauma lectures, "live free AND die" for 
the only state in the Union with  NO seat belt law! 
JES
> Send trauma-list mailing list submissions to
> 	trauma-list at trauma.org
> 
> To subscribe or unsubscribe via the World Wide Web, visit
> 	http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
> 	trauma-list-request at trauma.org
> 
> You can reach the person managing the list at
> 	trauma-list-owner at trauma.org
> 
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
> 
> 
> Today's Topics:
> 
>    1. Re: trauma-list Digest, Vol 41, Issue 32 (John E. Sutton Jr.)
>    2. RE: Privacy Issues (Bjorn, Pret)
>    3. RE: [EMS-L] The new edition of PHTLS (James Richardson)
>    4. Re: [EMS-L] The new edition of PHTLS (Andrew J Bowman)
>    5. RE: trauma-list Digest, Vol 41, Issue 32 (Robert Smith)
>    6. Conference Information Request (jkaymdc at aim.com)
>    7. What would you do? (Rafael Pinheiro)
>    8. Re: What would you do? (kmattox at aol.com)
>    9. Re: What would you do? (Ian Seppelt)
>   10. Re: What would you do? (kmattox at aol.com)
>   11. Re: Muscular trauma (Ronald Simon)
>   12. Re: What would you do? (Rafael Pinheiro)
>   13. Re: What would you do? (Ian Seppelt)
>   14. RE: What would you do? (Hardcastle, Tim, Dr <tch at sun.ac.za>)
>   15. Re: What would you do? (sandeep jain)
>   16. RE: What would you do? (Ian Seppelt)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: 28 Nov 2006 08:06:35 -0500
> From: John.E.Sutton.Jr at Hitchcock.ORG (John E. Sutton Jr.)
> Subject: Re: trauma-list Digest, Vol 41, Issue 32
> To: trauma-list at trauma.org
> Message-ID: <6740095 at mailbox3.Hitchcock.ORG>
> Content-Type: text/plain; charset=iso-8859-1
> 
> --- You wrote:
> 
> We have a 2 bed trauma bay that we are putting up a wall between the carts. 
> Have been told  that it is a "privacy issue" so we can no longer have an open
> room.  Anyone else having an issue like this and are you using any "creative
> ideas" to keep the room/bay open for multiple pts. 
> --- end of quote ---
> 
> When we built our new ED with a 3 bay trauma area and overhead X-ray, we were
> told by state regulators we needed radiologic shielding between the beds
> (hence, not open). We discussed walls, moveable radiologic shields ( not big
> enough and too cumbersome), and finally came up with radiologic "curtains"
> hanging from beams. They can be opened when you don't have all 3 beds full to
> give more space and yet do provide radiologic shielding and privacy when
> needed. 
> 
> John E. Sutton, Jr. , M.D., F.A.C.S.
> Division Chief, Trauma and Acute Surgical Care 
> Director of Trauma Services DHMC
> Professor of Surgery Dartmouth Medical School
> phone : 603-650-8022
> fax : 603-650-8030
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Tue, 28 Nov 2006 09:37:52 -0500
> From: "Bjorn, Pret" <pbjorn at emh.org>
> Subject: RE: Privacy Issues
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<86325BB1656A0F4BAC4611A956349E770702A7F3 at VALIER.me.emh.org>
> Content-Type: text/plain;	charset="us-ascii"
> 
> >From the AAST web site: 
> 
>  
> 
> "Incidental Use and Disclosure -- The final Rule acknowledges that uses
> or disclosures that are incidental to an otherwise permitted use or
> disclosure may occur. Such incidental uses or disclosures are not
> considered a violation of the Rule provided that the covered entity has
> met the reasonable safeguards and minimum necessary requirements. For
> example, if these requirements are met, doctors' offices may use waiting
> room sign-in sheets, hospitals may keep patient charts at bedside,
> doctors can talk to patients in semi-private rooms, and doctors can
> confer at nurse's stations without fear of violating the rule if
> overheard by a passerby."
> 
>  
> 
> I'm sure there are more specific recommendations regarding emergency and
> trauma care, but this summary points in the proper direction.  If you
> want to really over-interpret the statute, then we should have
> individual waiting rooms for every patient at triage, so that they can't
> see each other throw up.
> 
>  
> 
> HIPAA is not as fearsome as you might have been led to believe.  Do your
> best, of course; but emergency care is sometimes hard to hide.
> 
>  
> 
> Pret Bjorn, RN
> 
> Bangor, ME USA
> 
>  
> 
>  
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of ofiara at comcast.net
> Sent: Tuesday, November 28, 2006 6:37 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: Privacy Issues
> 
>  
> 
> Question
> 
>  
> 
> We have a 2 bed trauma bay that we are putting up a wall between the
> carts.  Have been told  that it is a "privacy issue" so we can no longer
> have an open room.  Anyone else having an issue like this and are you
> using any "creative ideas" to keep the room/bay open for multiple pts. 
> 
> Thanks Larry Ofiara, R.N., T.N.S.  Evanston, Il---
> 
>  
> 
>  
> 
>  
> 
> --------- Original message -------------- 
> 
> --
> 
> trauma-list : TRAUMA.ORG
> 
> To change your settings or unsubscribe visit:
> 
> http://www.trauma.org/traumalist.html
> 
>  
> 
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Tue, 28 Nov 2006 09:52:53 -0700
> From: "James Richardson" <jimmnn at comcast.net>
> Subject: RE: [EMS-L] The new edition of PHTLS
> To: <EMS-L at ems-l.org>, <Paramedicine at yahoogroups.com>,	"'Trauma &amp;
> 	Critical Care mailing list'" <trauma-list at trauma.org>
> Message-ID: <048b01c7130d$a9e77790$0300a8c0 at JimsDesktop>
> Content-Type: text/plain;	charset="US-ASCII"
> 
> A 40 page outline of the changes is available at http://tinyurl.com/yfz3cn
> 
> If you have trouble downloading please contact me directly and I have it in
> a pdf attachement.
> 
> Did not notice much new in terms of permissive hypotension but they are
> going with the latest research and recommending tourniquets over pressure
> points in severe bleeding control.
> 
>  Jim< 
> 
> --
> 
> 
> 
> Hello and sorry for the crossposting.
>  
> I am wondering what's new on the new edition of the PHTLS. Is there any link
> to a web site summarizing the changes? I am also interested in knowing
> whether there has been some further embracing of permissive hypotension in
> the new guidelines.
>  
> Thanks.
>  
> Gustavo E. Flores Bauer, MSIII EMT-P :.
> EmergencyTeam.Net
> San Juan, Puerto Rico
> Iberoamerican University School of Medicine
> Santo Domingo, Dominican Republic
>  
> 
> 
> 
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Tue, 28 Nov 2006 14:45:19 -0500
> From: "Andrew J Bowman" <andrewj.bowman at gmail.com>
> Subject: Re: [EMS-L] The new edition of PHTLS
> To: "Trauma &amp; Critical Care mailing list"
> 	<trauma-list at trauma.org>,	<EMS-L at ems-l.org>,
> 	<Paramedicine at yahoogroups.com>
> Message-ID: <006001c71325$bd560f40$09d1844a at 0021834017>
> Content-Type: text/plain;	charset="iso-8859-1"
> 
> The link you provided requires a password.
> 
> Can you send the pdf?
> 
> Andrew J Bowman, RN, BSN, MSN(c), TNS(c), CEN, CTRN, CCRN-CMC, BC, CVN-I,
> FACCN, NREMTP
> 
> ----- Original Message ----- 
> From: "James Richardson" <jimmnn at comcast.net>
> To: <EMS-L at ems-l.org>; <Paramedicine at yahoogroups.com>; "'Trauma &amp;
> Critical Care mailing list'" <trauma-list at trauma.org>
> Sent: Tuesday, November 28, 2006 11:52 AM
> Subject: RE: [EMS-L] The new edition of PHTLS
> 
> 
> > A 40 page outline of the changes is available at http://tinyurl.com/yfz3cn
> >
> > If you have trouble downloading please contact me directly and I have it
> in
> > a pdf attachement.
> >
> > Did not notice much new in terms of permissive hypotension but they are
> > going with the latest research and recommending tourniquets over pressure
> > points in severe bleeding control.
> >
> >  Jim<
> >
> > --
> >
> >
> >
> > Hello and sorry for the crossposting.
> >
> > I am wondering what's new on the new edition of the PHTLS. Is there any
> link
> > to a web site summarizing the changes? I am also interested in knowing
> > whether there has been some further embracing of permissive hypotension in
> > the new guidelines.
> >
> > Thanks.
> >
> > Gustavo E. Flores Bauer, MSIII EMT-P :.
> > EmergencyTeam.Net
> > San Juan, Puerto Rico
> > Iberoamerican University School of Medicine
> > Santo Domingo, Dominican Republic
> >
> >
> >
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> 
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Tue, 28 Nov 2006 15:26:25 -0500
> From: "Robert Smith" <rfsmithmd at comcast.net>
> Subject: RE: trauma-list Digest, Vol 41, Issue 32
> To: "'Trauma &amp; Critical Care mailing list'"
> 	<trauma-list at trauma.org>
> Message-ID: <000c01c7132b$7b29d8d0$0202fea9 at rob>
> Content-Type: text/plain;	charset="us-ascii"
> 
> I must admit that I've been pretty amused by this thread (because I don't
> have to deal with this BS any more!) and this was my favorite part. Did the
> "regulators" offer any scientific reason for their regulation? Did they also
> ask the regular staff to wear dosimeters which would have made more sense
> IMHO. I feel sorry for those of you who are just trying to figure out the
> best way to take care of the patients. Thank you for persevering.
> 
> R. Smith 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of John E. Sutton Jr.
> Sent: Tuesday, November 28, 2006 8:07 AM
> To: trauma-list at trauma.org
> Subject: Re: trauma-list Digest, Vol 41, Issue 32
> 
> --- You wrote:
> 
> We have a 2 bed trauma bay that we are putting up a wall between the carts.
> Have been told  that it is a "privacy issue" so we can no longer have an
> open room.  Anyone else having an issue like this and are you using any
> "creative ideas" to keep the room/bay open for multiple pts. 
> --- end of quote ---
> 
> When we built our new ED with a 3 bay trauma area and overhead X-ray, we
> were told by state regulators we needed radiologic shielding between the
> beds (hence, not open). We discussed walls, moveable radiologic shields (
> not big enough and too cumbersome), and finally came up with radiologic
> "curtains" hanging from beams. They can be opened when you don't have all 3
> beds full to give more space and yet do provide radiologic shielding and
> privacy when needed. 
> 
> John E. Sutton, Jr. , M.D., F.A.C.S.
> Division Chief, Trauma and Acute Surgical Care Director of Trauma Services
> DHMC Professor of Surgery Dartmouth Medical School phone : 603-650-8022 fax
> : 603-650-8030
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Tue, 28 Nov 2006 16:17:19 -0500
> From: jkaymdc at aim.com
> Subject: Conference Information Request
> To: EMED-L at ITSSRV1.UCSF.EDU, trauma-list at trauma.org
> Message-ID: <8C8E149B8C3EF10-724-71C0 at webmail-db13.sysops.aol.com>
> Content-Type: text/plain; charset="us-ascii"; format=flowed
> 
> Good Afternoon,
> 
> As we continue to work toward getting the information out and being
> assessable for questions from the EMS Community, we are once again
> requiring your help. We are compiling a calendar of EMS Conferences,
> tradeshows, seminars, symposiums we could possibly attend to discuss
> the Museum Project.
> 
> This calendar, once developed, will be updated with locations and dates
> of EMS events and will be vital in our development of Phase II--The
> Traveling Museum.
> 
> Please send me any information you have on the conferences, tradeshows,
> seminars and symposiums that are taking place in your area, whether
> local, regional, state or national. The following information is needed:
> 
> Conference Name
> Conference Date (s)
> Conference audience (EMS, Fire, EM, etc)
> Vendor Hall available
> Designate if a State, regional, local, national or international event
> 
> contact information:
> Name, email, phone number and website for conference contact.
> 
> Thank you so much for your continued support and participation in this
> project!!
> 
> Jules
> 
> 
> Julie K. Scadden, NREMT-P
> Secretary-National EMS Museum Foundation
> www.nationalemsmuseum.org
> jules.scadden at nationalemsmuseum.org
> 
> "National EMS Museum-Linking the Past, Present and Future of EMS"
> 
> 
> ________________________________________________________________________
> Check Out the new free AIM(R) Mail -- 2 GB of storage and 
> industry-leading spam and email virus protection.
> 
> 
> 
> ------------------------------
> 
> Message: 7
> Date: Tue, 28 Nov 2006 19:35:20 -0300 (ART)
> From: Rafael Pinheiro <rsnpinheiro at yahoo.com.br>
> Subject: What would you do?
> To: trauma-list at trauma.org
> Message-ID: <20061128223521.55545.qmail at web60425.mail.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> 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 
> 
>  		
> ---------------------------------
>  Novidade no Yahoo! Mail: receba alertas de novas mensagens no seu celular.
> Registre seu aparelho agora!
> 
> ------------------------------
> 
> Message: 8
> Date: Tue, 28 Nov 2006 23:27:35 +0000
> From: kmattox at aol.com
> Subject: Re: What would you do?
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<817269334-1164756359-cardhu_blackberry.rim.net-2048751393- at bwe002-
cell00.bisx.prod.on.blackberry>
> 	
> Content-Type: text/plain; charset="Windows-1252"
> 
> Ct of abd on way to OR or ICU.   Stay in ER 3 minutes 
> 
> K
> 
> 
> Sent via BlackBerry, return via KMattox at aol.com
>   
> 
> -----Original Message-----
> From: Rafael Pinheiro <rsnpinheiro at yahoo.com.br>
> Date: Tue, 28 Nov 2006 19:35:20 
> To:trauma-list at trauma.org
> Subject: What would you do?
> 
> 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 
> 
>         
> ---------------------------------
>  Novidade no Yahoo! Mail: receba alertas de novas mensagens no seu celular.
> Registre seu aparelho agora!
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> 
> ------------------------------
> 
> Message: 9
> Date: Wed, 29 Nov 2006 10:49:54 +1100
> From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
> Subject: Re: What would you do?
> To: <trauma-list at trauma.org>, <rsnpinheiro at yahoo.com.br>
> Message-ID: <s56d65dc.053 at EMPIRE>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> 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 
> 
>  		
> ---------------------------------
>  Novidade no Yahoo! Mail: receba alertas de novas mensagens no seu celular.
> Registre seu aparelho agora!
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> 
> ######################################################################
> Attention: 
> This message is intended for the addresses named and may contain 
> confidential information. If you are not the intended recipient, please
> delete it and notify the sender. Views expressed in this message are 
> those of the individual sender, and are not necessarily the views of 
> Sydney West Area Health Service.
> 
> 
> This e-mail has been scanned for viruses
> ######################################################################
> 
> 
> ------------------------------
> 
> Message: 10
> Date: Tue, 28 Nov 2006 23:57:57 +0000
> From: kmattox at aol.com
> Subject: Re: What would you do?
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<1413437806-1164758182-cardhu_blackberry.rim.net-1676580962- at bwe050-
cell00.bisx.prod.on.blackberry>
> 	
> Content-Type: text/plain; charset="Windows-1252"
> 
> I would NOT do a chest CT.  Simple chest X-ray.   
> 
> K
> 
> 
> Sent via BlackBerry, return via KMattox at aol.com
>   
> 
> -----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 
> 
>         
> ---------------------------------
>  Novidade no Yahoo! Mail: receba alertas de novas mensagens no seu celular.
> Registre seu aparelho agora!
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> 
> ######################################################################
> Attention: 
> This message is intended for the addresses named and may contain 
> confidential information. If you are not the intended recipient, please
> delete it and notify the sender. Views expressed in this message are 
> those of the individual sender, and are not necessarily the views of 
> Sydney West Area Health Service.
> 
> 
> This e-mail has been scanned for viruses
> ######################################################################
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> 
> ------------------------------
> 
> Message: 11
> Date: Tue, 28 Nov 2006 20:00:22 -0500
> From: Ronald Simon <Traumamd at nyc.rr.com>
> Subject: Re: Muscular trauma
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <456CDBA6.9080400 at nyc.rr.com>
> Content-Type: text/plain; charset=us-ascii; format=flowed
> 
> Passive movt should not be a problem. It is the active movt that would 
> leave me worried that the muscle would tear and separate.
> ron
> 
> Dean Lutrin wrote:
> 
> >Ron, thanks for the reply - any certainty about the decision to splint just
> >for a couple of days? Do you not think that one needs to splint for quite a
> >bit longer before starting passive movements?
> >
> >dean
> >
> >-----Original Message-----
> >From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> >On Behalf Of Ronald Simon
> >Sent: Monday, November 27, 2006 9:39 PM
> >To: Trauma &amp; Critical Care mailing list
> >Subject: Re: Muscular trauma
> >
> >Would try and anatomically repair the muscles. The muscle will not hold 
> >suture well so i would concentrate on suturing together tendons and 
> >sheaths where possible. That should approximate muscle bellies pretty 
> >well. Would then splint the arm for a couple of days and then start 
> >passive ROM and advance over the next 1-2 weeks.
> >ron simon
> >
> >Dean Lutrin wrote:
> >
> >  
> >
> >>Dear listmembers
> >>
> >>Something I have thought about but not explored properly... I did a case
> >>over the weekend of a 50 yr old male who was stabbed over his biceps with
> a
> >>beer bottle. He had a 15-20 laceration over the medial bicep area and a
> >>small laceration at the back as well. The glass had cut the brachial
> artery
> >>and the median nerve as well as a whole lot of muscles on the way. The
> >>arterial and nerve repair went just fine but (as before) I was not quite
> >>sure what to do with the muscle
> >>
> >>Should one - 
> >>1. attempt a proper anatomic approximation of each muscle?
> >>2. suture the muscle itself or only the sheath around each named muscle?
> >>3. Not really bother with too much repair and just 'tack it together?'
> >>
> >>Eagerly anticipating your replies...
> >>
> >>Cheers
> >>
> >>Dean Lutrin
> >>JHB,SA
> >>
> >>--
> >>trauma-list : TRAUMA.ORG
> >>To change your settings or unsubscribe visit:
> >>http://www.trauma.org/traumalist.html
> >>
> >> 
> >>
> >>    
> >>
> >
> >  
> >
> 
> 
> ------------------------------
> 
> Message: 12
> Date: Tue, 28 Nov 2006 23:31:44 -0300 (ART)
> From: Rafael Pinheiro <rsnpinheiro at yahoo.com.br>
> Subject: Re: What would you do?
> To: trauma-list at trauma.org
> Cc: seppelI at wahs.nsw.gov.au
> Message-ID: <362515.25476.qm at web60413.mail.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> Ok, I performed the DPL wich was negative, BP remaining low with 80-90bpm (O2
> sat. always above 93%), at this time with 2,5 liters of fluid. Trachea
> central and breath sounds still decresead in right base; pacient more
> agitated.
>   I inserted a right chest tube that drained some air, without persistent
> bubbling.
>    
>   And pacient get better! BP became to normal level and agitation passed
> away.
>    
>   The posterior radiologic studies were normal, and pacient has a good
> evolution.
>    
>   Strange case, didn´t it?? 
>    
>    
>   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
> 
> 
>  		
> ---------------------------------
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> ------------------------------
> 
> Message: 13
> Date: Wed, 29 Nov 2006 14:07:58 +1100
> From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
> Subject: Re: What would you do?
> To: <kmattox at aol.com>,	"Trauma &amp; Critical Care mailing list"
> 	<trauma-list at trauma.org>
> Message-ID: <s56d9467.037 at EMPIRE>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> I was referring to the unavoidable chest slices you get as part of your
> abdominal CT - a great source of VOMIT (ie yes there is aa tiny
> pneumothorax, but so what?!)
> Ian
> 
> >>> kmattox at aol.com 29/11/2006 10:57am >>>
> I would NOT do a chest CT.  Simple chest X-ray.   
> 
> K
> 
> 
> Sent via BlackBerry, return via KMattox at aol.com 
>   
> 
> -----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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> ------------------------------
> 
> Message: 14
> Date: Wed, 29 Nov 2006 06:48:26 +0200
> From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
> Subject: RE: What would you do?
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<3FE6F2A76FE75C418D3E0481CD75EA1E328CAB at TYGEVS01.tyg.sun.ac.za>
> Content-Type: text/plain;	charset="iso-8859-1"
> 
> 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 
> 
>  		
> ---------------------------------
>  Novidade no Yahoo! Mail: receba alertas de novas mensagens no seu celular.
> Registre seu aparelho agora!
> --
> trauma-list : TRAUMA.ORG
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> 
> ######################################################################
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> This message is intended for the addresses named and may contain 
> confidential information. If you are not the intended recipient, please
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> 
> 
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> 
> ------------------------------
> 
> Message: 15
> Date: Tue, 28 Nov 2006 20:59:41 -0800 (PST)
> From: sandeep jain <sjain7172 at yahoo.com>
> Subject: Re: What would you do?
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <977103.30682.qm at web50511.mail.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> I would like to get a central line in, see the CVP and
> continue resuscitation accordingly. Get a FAST and
> investigate for spinal injury as patient has
> hypotension without tachycardia. do get a history of
> any medication .
> 
> sandeep
> Trauma Surgeon,India
> --- Rafael Pinheiro <rsnpinheiro at yahoo.com.br> wrote:
> 
> > 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 
> > 
> >  		
> > ---------------------------------
> >  Novidade no Yahoo! Mail: receba alertas de novas
> > mensagens no seu celular. Registre seu aparelho
> > agora!
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> > 
> 
> 
> 
>  
> 
_______________________________________________________________________________
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> 
> ------------------------------
> 
> Message: 16
> Date: Wed, 29 Nov 2006 16:23:02 +1100
> From: "Ian Seppelt" <SeppelI at wahs.nsw.gov.au>
> Subject: RE: What would you do?
> To: <tch at sun.ac.za>,	"Trauma &amp; Critical Care mailing list"
> 	<trauma-list at trauma.org>
> Message-ID: <s56db400.077 at EMPIRE>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> No evidence to support that at all! SMALL pneumothoraces are best left
> well enough alone (especially the occult ones detected on CT that you
> would not have even diagnosed if you only did a chest X ray). The harm
> significantly outweighs the benefits, and in the pre CT era lots of
> these patients were anaesthetised without any problems at all. You
> certainly have an index of suspicion, and if there IS any deterioration
> you put a drain in, but the patient as presented did not have any signs
> of respiratory compromise except maybe reduced breath sounds
> (notoriously unreliable in a resuscitation room).
> 
> The attached BET review summarises the six relevant papers in the
> literature (admittedly none are level 1 evidence)
> 
> Cheers, Ian
> 
> >>> tch at sun.ac.za 29/11/2006 3:48pm >>>
> 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 
> 
>  		
> ---------------------------------
>  Novidade no Yahoo! Mail: receba alertas de novas mensagens no seu
> celular. Registre seu aparelho agora!
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html 
> 
> ######################################################################
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> This message is intended for the addresses named and may contain 
> confidential information. If you are not the intended recipient,
> please
> delete it and notify the sender. Views expressed in this message are 
> those of the individual sender, and are not necessarily the views of 
> Sydney West Area Health Service.
> 
> 
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> -------------- next part --------------
> A non-text attachment was scrubbed...
> Name: BET chest drain for occult pneumothorax
> 	2006.pdf
> Type: application/pdf
> Size: 67014 bytes
> Desc: not available
> Url :
> http://list.mistral.net/pipermail/trauma-
list/attachments/20061129/83c1076e/BETchestdrainforoccultpneumothorax2006.pdf
> 
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