List Archives

Tue Feb 13 17:35:39 GMT 2007

I probably would not operate either but at the slightest hint that there 
was a problem i would.
ron simon

Ronald Gross wrote:

>NOPE!  I would not operate on her.  What did you do?
>
>  
>
>>>>"Errington Thompson" <errington at erringtonthompson.com> 2/12/2007 6:18 PM >>>
>>>>        
>>>>
>Does this paper change anyone's mind?
>
> 
>
>Livingston DH,  Lavery RF,  Passannante MR,  Skurnick JH,  Baker S,  
>
>  Fabian TC,  Fry DE,  Malangoni MA  
>
>Free fluid on abdominal computed tomography without solid organ
>
>  injury after blunt abdominal injury does not mandate celiotomy.
>
> 
>
>In: Am J Surg (2001 Jul) 182(1):6-9
>
> 
>
>ISSN: 0002-9610
>
> 
>
>BACKGROUND: Mandatory celiotomy has been proposed for all patients with
>unexplained free fluid on abdominal computed tomography (CT) scanning after
>blunt abdominal injury. This recommendation has been based upon
>retrospective data and concerns over the potential morbidity from the late
>diagnosis of blunt intestinal injury. This study examined the rate of
>intestinal injury in patients with free fluid on abdominal CT after blunt
>abdominal trauma. METHODS: This study was a multicenter prospective series
>of all patients with blunt abdominal trauma admitted to four level I trauma
>centers over 22 months. Data were collected concurrently at the time of
>patient enrollment and included demographics, injury severity score,
>findings on CT scan, and presence or absence of blunt intestinal injury.
>This database was specifically queried for those patients who had free fluid
>without solid organ injury. RESULTS: In all, 2,299 patients were evaluated.
>Free fluid was present in 265. Of these, 90 patients had isolated free fluid
>with only 7 having a blunt intestinal injury. Conversely, 91% of patients
>with free fluid did not. All patients with free fluid were observed for a
>mean of 8 days (95% confidence interval 6.1 to 10.4, range 1 to 131). There
>were no missed injuries. CONCLUSIONS: Free fluid on abdominal CT scan does
>not mandate celiotomy. Serial observation with the possible use of other
>adjunctive tests is recommended.
>
> 
>
>So, is anyone aware of any data that suggests that back fractures have a
>higher incidence of bowel injuries?
>
> 
>
>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: rwolfer at aol.com [mailto:rwolfer at aol.com] 
>Sent: Monday, February 12, 2007 3:43 PM
>To: trauma-l at lists.aast.org 
>Subject: Re: Old lady in MVC
>
> 
>
>I have seen this before, in all types of patients, teens, old, adult and
>kids.  You really need to be worried about bowel injury esp with seat belt
>sign.  I would have  a very low threshold for exploration.  I have seen
>hemodynamically stable pts with complete bowel transections.  An elderly pt
>may not "take the hit" of delayed exploration very well.
>
> 
>
>Rebecca Wolfer, MD, FACS, FCCP
>Associate Professor, Marshall University School of Medicine
>Dept of Surgery
>Director Thoracic Surgery
>Director, Surgical Critical Care Cabell Huntington Hospital
>Director, Trauma Cabell Huntington Hospital
>
> 
>
> 
>-----Original Message-----
>From: jkcumming at yahoo.com 
>To: trauma-l at lists.aast.org 
>Sent: Mon, 12 Feb 2007 2:12 PM
>Subject: Re: FW: Old lady in MVC
>
>In the absence of solid organ injury, I would be concerned about the free
>fluid in the abdomen. Hollow viscus injury would have to be considered. The
>mesenteric hematoma could represent a bucket handle tear and associated
>bowel compromise.  In this case, I would low threshold for exploration.
>
> 
>
>John K. Cumming, M.D.
>
> 
>
>
>
>Errington Thompson <errington at erringtonthompson.com 
><javascript:parent.ComposeTo(> > wrote:
>
>I have a few questions on a case that I took care of recently. 
>
>92 yo female was a restrained passenger in a MVC. She was taken to an
>outside hospital. They got a chest x-ray and an x-ray of her knee. She was
>diagnosed with a patella fracture and was discharged. The patient became
>hypotensive when she got up to leave. The patient was transferred to our
>hospital. She arrived approximately 3 hours after her injury. She became
>hypotensive again as she rolled into the ER. The patient had gotten less
>than 500 cc of fluid prior to arrival. The patient was bolus with 2 L of
>normal saline.
>
>On physical examination, the patient had a positive "seatbelt sign" which
>was located above the umbilicus. The patient's abdomen was completely
>nontender above and below this sign. The patient was awake and alert. She
>was conversant.
>
>CT scan of the abdomen revealed a modest amount of free fluid with no
>abdominal injuries. Fluid could be seen around the liver, between the bowel
>and in the pelvis. There was a large mesenteric hematoma with no active
>extravasation. The patient was also noted to have an L3 compression
>fracture.
>
>Question: this patient is currently hemodynamically stable by whatever
>criteria you would like to use. Should this patient go to the operating
>room or should this patient be observed? (It is now almost 5 hours from the
>patient's motor vehicle crash.)
>
>Errington
>
>Errington C. Thompson, MD, FACS, FCCM
>Trauma/Surgical Critical Care
>Mission Hospital
>Asheville, NC
>Author - A Letter to America
>www.whereistheoutrage.net <http://www.whereistheoutrage.net/> 
>
> 
>Everyone deserves to make an informed decision
>                                - Errington Thompson, MD
>
>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org <javascript:parent.ComposeTo(>
>[mailto:trauma-list-bounces at trauma.org <javascript:parent.ComposeTo(> ]
>On Behalf Of Bjorn, Pret
>Sent: Monday, February 12, 2007 8:06 AM
>To: Trauma & Critical Care mailing list
>Subject: Steroids in SCI (was RE: (no subject))
>
>I see that everyone is rightly reluctant to pick at this scab. Either
>we all thought it was put to rest, or we find it too tiresome to bother
>with. Probably quite a lot of both.
>
>"...why does this issue keep rearing its ugly head..."
>
>PASG's. The Trendelenburg position. Atropine and asystole.
>Hyperventilation and brain injury. Iraq and 9/11. 
>
>Ignorance inspires, perpetuates, and vigorously defends myth. See also
>ANECDOTE in the glossary.
>
>"...what evidence is there to give MP in acute SCI..."
>
>There is of course more evidence NOT to give it. But in vivo, evidence
>and ignorance are evenly matched.
>
>"...is it considered efficacious..."
>
>No. But then, that's only considering the evidence.
>
>Pret Bjorn, RN
>Bangor, ME USA
>
>
>-----Original Message-----
>From: trauma-list-bounces at trauma.org <javascript:parent.ComposeTo(> 
>[mailto:trauma-list-bounces at trauma.org <javascript:parent.ComposeTo(> ] On
>Behalf Of candymsnjd at aol.com <javascript:parent.ComposeTo(> 
>Sent: Friday, February 09, 2007 7:04 PM
>To: trauma-list at trauma.org <javascript:parent.ComposeTo(> 
>Subject: (no subject)
>
>help why does this issue keep rearing its ugly head...what evidence is
>there to give MP in acute SCI? Is it considered efficacious....
>________________________________________________________________________
>Check out the new AOL. Most comprehensive set of free safety and
>security tools, free access to millions of high-quality videos from
>across the web, free AOL Mail and more.
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html 
>
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/index.php?/community/ 
>
>
>
>---------------------------------------------------------------------
>To unsubscribe, e-mail:
>trauma-l-unsubscribe-jkcumming=yahoo.com at lists.aast.org 
><javascript:parent.ComposeTo(> 
>For additional commands, e-mail: trauma-l-help at lists.aast.org 
><javascript:parent.ComposeTo(> 
>For additional information see, http://www.aast.org/lists.html 
>
> 
>
>  _____  
>
>We won't tell. Get more on shows you hate to love
>(and love to hate): Yahoo! TV's Guilty Pleasures list. 
>
>  _____  
>
> 
><http://pr.atwola.com/promoclk/1615326657x4311227241x4298082137/aol?redir=ht 
>tp%3A%2F%2Fwww%2Eaol%2Ecom%2Fnewaol> Check out the new AOL. Most
>comprehensive set of free safety and security tools, free access to millions
>of high-quality videos from across the web, free AOL Mail and more.
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/index.php?/community/
>
>Confidentiality Notice
>
>This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential or proprietary information which is legally privileged.  Any unauthorized review, use, disclosure, or distribution is prohibited.  If you are not the intended recipient, please promptly contact the sender by reply e-mail and destroy all copies of the original message.
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/index.php?/community/
>
>  
>

-- 
Ronald Simon, MD
Dir of Trauma/SICU
Jacobi Medical Center, Rm 1213
Bronx, NY 10461
718 918 5598 phone
718 918 5593 fax

List Archives

For your convenience, find the Trauma List Archive Below

Old lady in MVC