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Wed Sep 6 17:33:54 BST 2006

19 yo dirt bike crash. Presents with ABD pain.  Workup reveals a transected
pancreas.  Patient taken to the OR.  Distal pancreatectomy.  Post Op.
patient develops an ileus.  TPN started.  Patient up ambulating.  He was
switched from Lovenox BID which was started post op to once daily dosing 40
mg.  3 days later the patient is confused.  Pulls out IV and hypoxic.  CTA
of the chest revealed a PE.  U/S were negative of groins/legs/arms for DVT.

Any thoughts on whether this patient needed DVT prophylaxis and if so what
should the dosage be?

E

Errington C. Thompson, MD, FACS, FCCM

Trauma/Surgical Critical Care

Mission Hospital

Asheville, NC

Author - A Letter to America

www.whereistheoutrage.net <http://www.erringtonthompsonmd.com/> 

Everyone deserves to make an informed decision

                                - Errington Thompson, MD

  _____  

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of johan.malmgren at vgregion.se
Sent: Wednesday, September 06, 2006 9:06 AM
To: trauma-list at trauma.org
Subject: OT: Compartment prevention perioperatively

List! 

Would be grateful for some input although a bit off topic. 

20 y/o boy reoperated upon yesterday with a urethroplasty, buccal graft.
Otherwise healthy, I'd guess 1.85 cm/85 kg. 

At earlier similar operation it had been noted a tendency for decubitus, so
everybody took extra precautions. Operation lasted some 15 hours, under
which the legs were lowered a couple of times, and I even think a nurse
massaged them. BP was steady as a rock the entire time, no need for
inotropic drugs. 

Still develops bilateral compartment-syndrome and was bilat fasciotomied
later same night.

The discussion today was of course prevention, and the question raised was
if we should routinely have ortho come and measure pressure perioperatively
during these kind of operations. (I guess the same would apply for some
robotic-surgery operations were the patient almost hangs upside down) On the
other hand, as far as I know, that would tell us when to open his legs and
in an elective case like this, that already seems "too late".

Any ideas? Would be happy to hear what your local routines tells about this!

/Johan Malmgren

MD, Anaesthesia and Critical Care/Trauma

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DVT prophylaxis question