GSW to liver

• Previous message: GSW to liver
• Next message: GSW to liver
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

I see I entered this conversation very late.




----------------------------------------
> From: errington at erringtonthompson.com
> To: trauma-list at trauma.org
> Date: Sun, 30 Dec 2007 00:06:51 -0500
> Subject: GSW to liver
> 
> I have a couple of questions on a recent case.  30 yo male was too drunk to
> have a gun but had one nonetheless.  He shot himself in the right upper
> quadrant.  He was stable, awake and talking in the ER.  Entrance wound
> easily seen just under the ribs and just lateral to the mid-clavicular line.
> The bullet was palpable just under the skin at about the 12th rib.  No SOB.
> 
> 
> 1) CT or not CT scan.  IF you do scan the patient and see a thru and thru
> wound the liver, can you just watch him?
> 
> I take the patient to the OR.  He indeed has a thru and thru GSW to the
> liver.  The wounds are not really bleeding.  There is no bile oozing from
> either wound.
> 
> 2) Drain or no drain?
> 
> The patient develops an ileus and bile peritonitis.  He is percutaneously
> drained.  On day 5 with his drain output still over 300 cc per day the
> character of the drainage changes to a dark green.  CT scan revealed an
> abscess posterior to the liver.  Percutaneous drainage was performed.
> Enterococcus in the fluid.  Antibiotics were started.  Antiobiotics stopped
> after 7 days. 
> 
> Thoughts?
> 
> 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
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

_________________________________________________________________
Don't get caught with egg on your face. Play Chicktionary!
http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec

• Previous message: GSW to liver
• Next message: GSW to liver
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]