List Archives

Wed Dec 26 15:29:08 GMT 2007

Dear All,

Happy Eid Mubarak,
Merry Christmas,
Happy New year.

I hope that all of us are having a good holiday season.

I am looking for and if possible a copy of:-
1. A good article/ reference on analgesia in trauma
2. Traumatic cardiac tamponade

With regards,

Zunorain Dodhy MRCS Ed
Bahrain

----- Original Message ----
From: "trauma-list-request at trauma.org" <trauma-list-request at trauma.org>
To: trauma-list at trauma.org
Sent: Wednesday, 26 December, 2007 3:00:25 PM
Subject: trauma-list Digest, Vol 54, Issue 34

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Today's Topics:

   1. Re: BAT (kmattox at aol.com)
   2. RE: BAT (Pret Bjorn)
   3. Re: BAT (Trauma Doc)
   4. Re: BAT (Andrew J Bowman)

-----Inline Message Follows-----

No oral contrast for trauma. 

K

Sent via BlackBerry by AT&T

-----Original Message-----
From: "Ronald Gross" <Rgross at harthosp.org>

Date: Tue, 25 Dec 2007 06:49:38 
To:<trauma-list at trauma.org>
Subject: Re: BAT

Scan the abdomen with IV contrast only - there is no need for PO
 contrast in the acute trauma setting.
Merry Christmas and Happy Holidays to all,
Ron

>>> <ccrone at charter.net> 12/25/2007 12:37 AM >>>
I work at a small, rural ER (about 18, 000 annual ED volume).  We have
 no FAST/Ultrasound immediately available at all times.  If we have a
 case of blunt abdominal trauma & order a CT scan, our radiologist demands
 that we have the patient drink oral contrast & wait 2 hours for the CT
 to be performed.  It then takes another 30 minutes for the report to
 be obtained.    What do other institutions currently do regarding the
 use of oral contrast when obtaining abdominal/pelvic CT's for blunt
 abdominal trauma in a hemodynamically stable patient-- with suspected
 internal injuries?

Thanks 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

-----Inline Message Follows-----

If your major decisions can wait three hours, this better not be
 trauma. 

Unless you have a surgeon in the room, defer ALL your CT's and focus on
transfer.  Get an AP chest film and splint everything else.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
 [mailto:trauma-list-bounces at trauma.org]
On Behalf Of ccrone at charter.net
Sent: Tuesday, December 25, 2007 12:38 AM
To: trauma-list at trauma.org
Subject: BAT

I work at a small, rural ER (about 18, 000 annual ED volume).  We have
 no
FAST/Ultrasound immediately available at all times.  If we have a case
 of
blunt abdominal trauma & order a CT scan, our radiologist demands that
 we
have the patient drink oral contrast & wait 2 hours for the CT to be
performed.  It then takes another 30 minutes for the report to be
 obtained.
What do other institutions currently do regarding the use of oral
 contrast
when obtaining abdominal/pelvic CT's for blunt abdominal trauma in a
hemodynamically stable patient-- with suspected internal injuries?

Thanks 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

-----Inline Message Follows-----

Waiting 2 hours is not necessary and may be dangerous.  PO contrast
 adds
very little.  Water soluble contrast down the NGT or taken PO within a
 few
minutes of the scan is fine and may help identify a proximal duodenal
injury, if present.  As for waiting for a reading, that is also not
necessary and may be dangerous.  The high potential for rapid
 decompensation
always exists.  All CT imaging is read by us (trauma surgeons) as soon
 as
the images are available, which is generally before the patient is even
 off
the scanner.  A radiologist reviews the scans at a later time.
  Although we
may miss tiny injuries (a thoracic transverse process fracture for
 example),
solid organ injury, free air, free fluid, pneumothoraces, and vascular
injuries (thoracic and abdominal) are easily identified even by the
neophyte.  Additionally, a brief look at brain CT imaging will easily
identify lesions that require emergent neugosurgical intervention.

>
> Today's Topics:
>
>   1. BAT (ccrone at charter.net)
>   2. Re: BAT (SJASMD at aol.com)
>   3. Re: BAT (Gad Shaked)
>   4. Re: BAT (Ronald Gross)
>
>
>
 ----------------------------------------------------------------------
>
> Message: 1
> Date: Mon, 24 Dec 2007 21:37:46 -0800
> From: <ccrone at charter.net>
> Subject: BAT
> To: trauma-list at trauma.org
> Message-ID: <20071225003746.SVITD.115026.root at fepweb13>
> Content-Type: text/plain; charset=utf-8
>
> I work at a small, rural ER (about 18, 000 annual ED volume).  We
 have no
> FAST/Ultrasound immediately available at all times.  If we have a
 case of
> blunt abdominal trauma & order a CT scan, our radiologist demands
 that we
> have the patient drink oral contrast & wait 2 hours for the CT to be
> performed.  It then takes another 30 minutes for the report to be
> obtained.    What do other institutions currently do regarding the
 use of
> oral contrast when obtaining abdominal/pelvic CT's for blunt
 abdominal
> trauma in a hemodynamically stable patient-- with suspected internal
> injuries?
>
> Thanks
>
>
> ------------------------------
>

-----Inline Message Follows-----

When a major trauma hits your door, stabilize ABC's and arrange for
 prompt 
transfer out to higher level of care. You will be doing well by your 
patients instead of potentially harming them with this antiquated CT 
protocol.

Andrew
(also working in a small ER but do not have protocols like this)
(and no FAST/US either)

>>
>> I work at a small, rural ER (about 18, 000 annual ED volume).  We
 have no
>> FAST/Ultrasound immediately available at all times.  If we have a
 case of
>> blunt abdominal trauma & order a CT scan, our radiologist demands
 that we
>> have the patient drink oral contrast & wait 2 hours for the CT to be
>> performed.  It then takes another 30 minutes for the report to be
>> obtained.    What do other institutions currently do regarding the
 use of
>> oral contrast when obtaining abdominal/pelvic CT's for blunt
 abdominal
>> trauma in a hemodynamically stable patient-- with suspected internal
>> injuries?
>>
>> Thanks
>>
>>

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/No oral contrast for trauma. 

K

Sent via BlackBerry by AT&T

-----Original Message-----
From: "Ronald Gross" <Rgross at harthosp.org>

Date: Tue, 25 Dec 2007 06:49:38 
To:<trauma-list at trauma.org>
Subject: Re: BAT

Scan the abdomen with IV contrast only - there is no need for PO
 contrast in the acute trauma setting.
Merry Christmas and Happy Holidays to all,
Ron

>>> <ccrone at charter.net> 12/25/2007 12:37 AM >>>
I work at a small, rural ER (about 18, 000 annual ED volume).  We have
 no FAST/Ultrasound immediately available at all times.  If we have a
 case of blunt abdominal trauma & order a CT scan, our radiologist demands
 that we have the patient drink oral contrast & wait 2 hours for the CT
 to be performed.  It then takes another 30 minutes for the report to
 be obtained.    What do other institutions currently do regarding the
 use of oral contrast when obtaining abdominal/pelvic CT's for blunt
 abdominal trauma in a hemodynamically stable patient-- with suspected
 internal injuries?

Thanks 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

If your major decisions can wait three hours, this better not be
 trauma. 

Unless you have a surgeon in the room, defer ALL your CT's and focus on
transfer.  Get an AP chest film and splint everything else.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
 [mailto:trauma-list-bounces at trauma.org]
On Behalf Of ccrone at charter.net
Sent: Tuesday, December 25, 2007 12:38 AM
To: trauma-list at trauma.org
Subject: BAT

I work at a small, rural ER (about 18, 000 annual ED volume).  We have
 no
FAST/Ultrasound immediately available at all times.  If we have a case
 of
blunt abdominal trauma & order a CT scan, our radiologist demands that
 we
have the patient drink oral contrast & wait 2 hours for the CT to be
performed.  It then takes another 30 minutes for the report to be
 obtained.
What do other institutions currently do regarding the use of oral
 contrast
when obtaining abdominal/pelvic CT's for blunt abdominal trauma in a
hemodynamically stable patient-- with suspected internal injuries?

Thanks 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

Waiting 2 hours is not necessary and may be dangerous.  PO contrast
 adds
very little.  Water soluble contrast down the NGT or taken PO within a
 few
minutes of the scan is fine and may help identify a proximal duodenal
injury, if present.  As for waiting for a reading, that is also not
necessary and may be dangerous.  The high potential for rapid
 decompensation
always exists.  All CT imaging is read by us (trauma surgeons) as soon
 as
the images are available, which is generally before the patient is even
 off
the scanner.  A radiologist reviews the scans at a later time.
  Although we
may miss tiny injuries (a thoracic transverse process fracture for
 example),
solid organ injury, free air, free fluid, pneumothoraces, and vascular
injuries (thoracic and abdominal) are easily identified even by the
neophyte.  Additionally, a brief look at brain CT imaging will easily
identify lesions that require emergent neugosurgical intervention.

>
> Today's Topics:
>
>   1. BAT (ccrone at charter.net)
>   2. Re: BAT (SJASMD at aol.com)
>   3. Re: BAT (Gad Shaked)
>   4. Re: BAT (Ronald Gross)
>
>
>
 ----------------------------------------------------------------------
>
> Message: 1
> Date: Mon, 24 Dec 2007 21:37:46 -0800
> From: <ccrone at charter.net>
> Subject: BAT
> To: trauma-list at trauma.org
> Message-ID: <20071225003746.SVITD.115026.root at fepweb13>
> Content-Type: text/plain; charset=utf-8
>
> I work at a small, rural ER (about 18, 000 annual ED volume).  We
 have no
> FAST/Ultrasound immediately available at all times.  If we have a
 case of
> blunt abdominal trauma & order a CT scan, our radiologist demands
 that we
> have the patient drink oral contrast & wait 2 hours for the CT to be
> performed.  It then takes another 30 minutes for the report to be
> obtained.    What do other institutions currently do regarding the
 use of
> oral contrast when obtaining abdominal/pelvic CT's for blunt
 abdominal
> trauma in a hemodynamically stable patient-- with suspected internal
> injuries?
>
> Thanks
>
>
> ------------------------------
>

When a major trauma hits your door, stabilize ABC's and arrange for
 prompt 
transfer out to higher level of care. You will be doing well by your 
patients instead of potentially harming them with this antiquated CT 
protocol.

Andrew
(also working in a small ER but do not have protocols like this)
(and no FAST/US either)

>>
>> I work at a small, rural ER (about 18, 000 annual ED volume).  We
 have no
>> FAST/Ultrasound immediately available at all times.  If we have a
 case of
>> blunt abdominal trauma & order a CT scan, our radiologist demands
 that we
>> have the patient drink oral contrast & wait 2 hours for the CT to be
>> performed.  It then takes another 30 minutes for the report to be
>> obtained.    What do other institutions currently do regarding the
 use of
>> oral contrast when obtaining abdominal/pelvic CT's for blunt
 abdominal
>> trauma in a hemodynamically stable patient-- with suspected internal
>> injuries?
>>
>> Thanks
>>
>>

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