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Mon Aug 13 14:31:08 BST 2007

Hi everyone:
I have one question, what does is 12 lead EKG show? Is there an  
obvious injury to the heart, that you can not visualize? Or this a  
test that you would not perform in this type of situation?
Carol Eisenbrandt

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> Today's Topics:
>
>    1. Estimated fluid and blood losses classification.
>       (JOSE SUAREZ PELAEZ)
>    2. Re : Implementing 1 to1 pRBCs to FFP for Resuscitation
>       (Jean-Pierre Arsenault)
>    3. Re: UPPER MEDIASTINUM Trans thoracic INJURY. (Ben Reynolds)
>    4. Re: UPPER MEDIASTINUM Trans thoracic INJURY. (KMATTOX at aol.com)
>    5. Re: UPPER MEDIASTINUM Trans thoracic INJURY clarifications
>       for BEN (SJASMD at aol.com)
>    6. Quikclot (Ruy Cabello-Pasini)
>    7. RE: unique penetrating injury
>       (Hardcastle, Tim, Dr <tch at sun.ac.za>)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Sun, 12 Aug 2007 12:17:23 +0100
> From: "JOSE SUAREZ PELAEZ" <josuarez at teleline.es>
> Subject: Estimated fluid and blood losses classification.
> To: <trauma-list at trauma.org>
> Message-ID: <003301c7dcd2$5f1a4af0$2501a8c0 at pc>
> Content-Type: text/plain;	charset="iso-8859-1"
>
> I can´t find the first publication of the "Estimated fluid and blood  
>  losses" classification. Does anyone can help me?
>
> J.Suález-Peláez.
>
> ------------------------------
>
> Message: 2
> Date: Sun, 12 Aug 2007 04:26:32 -0700 (PDT)
> From: Jean-Pierre Arsenault <jparseno at yahoo.com>
> Subject: Re : Implementing 1 to1 pRBCs to FFP for Resuscitation
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <541191.15123.qm at web32511.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> Just how do you prove that?
>
> ----- Message initial ----
> De : Errington Thompson  <errington at erringtonthompson.com>
> À : "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Envoyé le : vendredi 10 août 2007, 23 h 44 min 27 s
> Objet : RE: Implementing 1 to1 pRBCs to FFP for Resuscitation
>
> I believe that this approach will save a lot of people.  Since adopting a
> similar approach about 2 years ago, 4 - 5 people have been saved who would
> have bled out using the old technique.
>
> E
>
>
>
>
>
>
>
>       Le tout nouveau Yahoo! Courriel. Consultez vos fils RSS depuis  
>  votre boîte de réception.    
> http://us.rd.yahoo.com/evt=40705/*http://mrd.mail.yahoo.com/try_beta?.intl=cf
>
>
> ------------------------------
>
> Message: 3
> Date: Sun, 12 Aug 2007 08:29:10 -0700 (PDT)
> From: Ben Reynolds <aneurysm_42 at yahoo.com>
> Subject: Re: UPPER MEDIASTINUM Trans thoracic INJURY.
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <483415.14935.qm at web56613.mail.re3.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> Ok, I'll play.
>
> With the information given I'll make several
> assumptions:
>
> 1.  In the absence of any evidence of head injury
> (noting that it is unclear to me whether the injury to
> the lip is upper or lower or whether he has stigmata
> of a penetrating wound to the head) or profound
> hypoxia, the blown pupil may represent a CNS injury as
> stated previously by Ken, most likely by an embolic
> stroke to the brain from, I would surmise an injury to
> the transverse aortic arch or one of the great
> vessels.
>
> More unlikely it may represent some weird sympathetic
> chain injury not Horner's.
>
> It would be helpful to know whether this gentleman has
> a pulse in his left hand, whether the blood pressures
> in both upper extremities are unequal, or whether a
> bruit over the base of his left carotid is present.
>
> 2.  Unless the chest xray was provacative for a left
> hemothorax, I would not place a second chest tube
> unless I was really concerned that there should have
> been more output with the intital placement as would
> be evidenced by an impressive chest xray or
> hemodynamic instability.  My feeling is that the low
> initial chest tube output is diagnostic for contained
> mediastinal injury, given the stated location of the
> injury and it's presumed trajectory.
>
> 3.  Given that this in all likelihood represents a
> contained upper mediastinal injury, any further
> imaging (whether aortography or CT scanning) may prove
> to be CONFOUNDING and MISLEADING when in fact the
> definitive DIAGNOSTIC and THERAPEUTIC intervention is
> mediastinal exploration.
>
> That said, I believe that one could choose antecedent
> aortography and not be wrong predicated on the
> patient's hemodynamic stability and with the
> understanding that performing it does NOT negate the
> need for surgical exploration.
>
> My approach would be median sternotomy with left neck
> extension, keeping in mind that this may require a
> trap door on the left.
>
> Ben Reynolds, PA-C
> Pittsburgh, PA
>
> --- KMATTOX at aol.com wrote:
>
>> TO THE MEMBERS OF THIS LIST SERVER
>>
>> Sal Sclafani has whetted our appetites with a
>> complex  case.    From the
>> literature there are MULTIPLE RIGHT ways to
>> evaluate and treat this patient.
>> Multiple imaging, endoscopic,  and lab challenges
>> exist and all of them have
>> appeared in the literature.
>>
>> MULTIPLE incisions, positions, and techniques have
>> been  described.    This
>> is the kind of case that seasoned CARDIAC and
>> VASCULAR surgeons are more
>> confused than most of the TRAUMA surgeons, but they
>> will not admit it.
>>
>> I strongly encourage each of you to READ the CASE
>> and COMMIT yourself to a
>> workup and follow Sal as he dribbles out clues as
>> they unfold.     TO MAXIMALLY
>> benefit you must commit yourself and give an
>> opinion.   I  will promise that
>> both Sal and I will fully respect your  views.
>> Just to show that there are
>> glitches,   TWO  of the things that I stated in my
>> post are completely
>> opposite to things I have  writtened in the past.
>>
>> JOIN this fun discussion.
>>
>> k
>>
>>
>>
>> ************************************** Get a sneak
>> peek of the all-new AOL at
>> http://discover.aol.com/memed/aolcom30tour
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>
>
>
> ------------------------------
>
> Message: 4
> Date: Sun, 12 Aug 2007 11:37:34 EDT
> From: KMATTOX at aol.com
> Subject: Re: UPPER MEDIASTINUM Trans thoracic INJURY.
> To: trauma-list at trauma.org
> Message-ID: <d49.e65225d.33f0833e at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
> In a message dated 8/12/2007 10:29:55 A.M. Central Daylight Time,
> aneurysm_42 at yahoo.com writes:
>
> Unless  the chest xray was provacative for a left
> hemothorax, I would not place a  second chest tube
> unless I was really concerned that there should  have
> been more output
>
>
> SAL, Please share the chest X-ray if possible.    THis would  cause us all to
> make more speculations
>
> k
>
>
>
> ************************************** Get a sneak peek of the all-new AOL at
> http://discover.aol.com/memed/aolcom30tour
>
>
> ------------------------------
>
> Message: 5
> Date: Sun, 12 Aug 2007 12:33:47 EDT
> From: SJASMD at aol.com
> Subject: Re: UPPER MEDIASTINUM Trans thoracic INJURY clarifications
> 	for BEN
> To: trauma-list at trauma.org
> Message-ID: <d3e.10aa82f0.33f0906b at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
> In a message dated 8/12/2007 5:38:26 PM W. Europe Daylight Time,
> KMATTOX at aol.com writes:
>
>
> In a message dated 8/12/2007 10:29:55 A.M. Central Daylight Time,
> aneurysm_42 at yahoo.com writes:
>
> Unless  the chest xray was provacative for a left
> hemothorax, I would not place a  second chest tube
> unless I was really concerned that there should  have
> been more output
>
>
> SAL, Please share the chest X-ray if possible.    THis would  cause us all to
> make more speculations
>
> k
>
> I will transmit the initial chest xray when i return to the hospital in the
> morning.
> As best I can recall and describe
>
> 1. There was a left thoracostomy tube in good position, there was not very
> much residual hemothorax
> 2. There was bilateral air space opacification consistent with aspiration
> 3. There was a widened mediastinum with no obvious focal hematoma
> 4. There was no apical hematoma
> 5. The nasogastric tube was interpreted to be deviated to the right. I didnt
> agree with that
> 6. an unfragmented bullet was seen in the right supraclavicular area , i
> believe laterally.
>
> Ben asks some good questions
>
> the man had pulses in both hands,
> blood pressures were not measured in both arms
> he had no bruit
>
> The lip injury was to the  upper lip with a tooth missing. At this point the
> surgeon was unclear whether this represented a penetration of the lip
> extending into the neck or brain or something as simple as a   
> laceration from a fall.
>
>
> I look forward to more discussions. I will share that radiograph tomorrow.
>
> sal
>
>
>
> ************************************** Get a sneak peek of the all-new AOL at
> http://discover.aol.com/memed/aolcom30tour
>
>
> ------------------------------
>
> Message: 6
> Date: Sun, 12 Aug 2007 16:18:14 -0700 (PDT)
> From: Ruy Cabello-Pasini <ruycabello at yahoo.com>
> Subject: Quikclot
> To: trauma-list at trauma.org
> Message-ID: <731966.47021.qm at web50909.mail.re2.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> Anybody out there in the list have experience with
> Quikclot? I am aware only of a lot of advertising and
> the basic experimental data (Holcomb, Rhee, etc) Is it
> still in use by the Military at Irak? Is the thermal
> injury really an issue?  I was currently asked to
> evaluate the product for use in our institution
> (Mexican Army).  Thanks for your opinion.
>
> Ruy Cabello-Pasini, MD
> Trauma Surgeon
>
>
>
> ____________________________________________________________________________________
> Yahoo! oneSearch: Finally, mobile search
> that gives answers, not web links.
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>
>
> ------------------------------
>
> Message: 7
> Date: Mon, 13 Aug 2007 07:00:25 +0200
> From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
> Subject: RE: unique penetrating injury
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<3FE6F2A76FE75C418D3E0481CD75EA1E329271 at TYGEVS01.tyg.sun.ac.za>
> Content-Type: text/plain;	charset="iso-8859-1"
>
> Sal
>
> Item 1: Find the possible missing bullet, or the exit wound! (?Lip entry)
>
> Safe Assumption: Transmediastinal bullet in chest. - If stable CT   
> Chest, while you're there CT neck with CTA, as screening, also do   
> contrast swallow - proceed to surgery if needed, or to endovascular   
> therapy if you have the means. The "blown pupil" is likely to be a   
> vascular injury.
>
> Regards
> 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 SJASMD at aol.com
> Sent: Saturday, August 11, 2007 5:01 PM
> To: trauma-list at trauma.org
> Subject: unique penetrating injury
>
>
> A 37 YO man is brought in by EMS after sustaining multiple gunshot wounds. He
> has a GCS of 7 with a possible blown pupil, absent right breath sounds, blood
> in his mouth and adequate blood pressure. He is a  difficult intubation and
> requires cricothyroidotomy. He gets a right chest tube.He is hyper capneic,
> adequately oxygenated and acidotic with base deficiit of -7.
>
> Examination shows three penetrations: one to the lip with no exit wound, an
> entry in the LEFT anterior infraclavicular area and one to the   
> thigh. There is
> no major bleeding, or hematomas.
>
> Chest xray  shows opacities consistent with aspiration, ( likely of blood
> from the mouth), a widened mediastinum and a bullet in the RIGHT   
> supraclavicular
> region, with minimal hemothorax. Other portable xrays showed a bullet in the
> thigh with no fracture and no other bullets in the torso.
>
> How to proceed
>
> sal sclafani
>
>
>
>
> ************************************** Get a sneak peek of the all-new AOL at
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>
> ------------------------------
>
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