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Thu Aug 23 14:59:55 BST 2007

initial message:

-seems like we are having a duet here, so i think we should come to the end of 
-the story rather than force everyone to delete our emails

I don't think that because of the fact not many people responded that this discussion wasn't interesting.  It is deceiving that not many level I surgeons responded with an opinion.

I'm sure a whole bunch of peripheral general surgeons like me just acted like spectators because we didn't feel our opinion would be of importance, and also because of the fact that we would'nt operate on this anyway, leaving it to the thoracic/vascular surgeon of our closest level I center.  In Canada, nobody gets as much penetrating trauma as you guys (not even close!), so there aren't much do-it-all trauma surgeons.

I don't have pumps, grafts of all possible sizes, enough experience with mediastinal surgery to get into a case like this.  I don't even have angio in my center!  

Si this case would be transfer for me.  But it's interesting to see that even a penetrating mediastinum injury like this one could be considered a bit less urgent, leaving time to take care of a immediate more life-threatening (more peripheral) injury, and then transfering for the big stuff in the mediastinum (we don't have medical helicopters so a transfer is at least two hours in an ambulance)

Sorry the guy didn't make it through.  

By the way, why wasn't a pump available?  would it not help in some cases?

So don't despair even if you have the impression to be a duet, a lot of people are listening...

Jean-Pierre Arsenault, general surgeon
Rivière-du-Loup, Québec, Canada

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