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Sat Oct 7 11:19:21 BST 2006

Fx ribs 10, 11, 12 on the left:  three total.

Pret

----- Original Message -----
From: "Errington Thompson" <errington at erringtonthompson.com>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Saturday, October 07, 2006 10:47 AM
Subject: RE: NoM Spleen Returns

At my institution, the station would have been embolized on a first
admission.

10 to 12 rib fractures?  That usually keeps patients in the hospital for
five to seven days.  What magic things are you doing?

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

Everyone deserves to make an informed decision
- Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Friday, October 06, 2006 12:19 PM
To: trauma-list at trauma.org
Subject: NoM Spleen Returns

Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as Grade
I in spite of contrast blush (not intended as the thrust of this
thread).

The patient was admitted for two nights, stable throughout, and
discharged with her cooperation and enthusiasm.  She was prescribed
house arrest for a week, drastically limited activity, and an office
visit to follow.

As fate would have it, on post-injury day 6 she suffered a sudden sharp
LUQ pain with what sounds like a brief vagal response.  She reported
immediately to her local ED, where another CT shows both a persistent
blush plus intraperitoneal hemorrhage (second image).

At the local hospital, vitals were stable (she was in fact hypertensive
consistent with her medical history) and her labs were unremarkable (H&H
12 and 35, roughly identical to previous discharge numbers).  She was
admitted to the local hospital for observation, but her counts slipped
overnight (10 & 27), and so she was transferred back to us.  She arrives
stable and without any major complaints.  Even a little hungry.

Interested in what others would plan for her.  Observe?  Coil?  Both?
Other?

Pret Bjorn, RN

 <<FirstImage.jpg>>  <<SecondImage.jpg>>

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NoM Spleen Returns