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Tue Feb 13 21:02:13 GMT 2007

Okay, I'm here to learn, so be gentle with me.

Did it have to be emboli?  

I know the patient was described as "stable by any measure," but there's
reference to fluid and blood boluses, which I assume weren't just for
urine output.  Couldn't a stretch of relative hypoperfusion have caused
diffuse brain injury?

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com
Sent: Tuesday, February 13, 2007 3:51 PM
To: trauma-list at trauma.org; ccm-l at ccm-l.org
Subject: Re: ccml RE: Old lady in MVC

In a message dated 2/13/2007 2:36:59 PM Central Standard Time,  
errington at erringtonthompson.com writes:

Wouldn't  emboli give a specific vascular distribution?  She didn't have
that.  

from the carotids, maybe, unless there was vascular disease on both
sides.  
>From a left atrial clot, possibly not. I've defiantly seen enough
'organic 
brain  syndrome' patients over the years where there was evidence of
frequent, 
randomly  distributed microembolic disease. I will admit that this level
of 
acuity (large  scale shower over the space of hours to a day or two at
the most) is 
unusual,  but it's worth checking out.

I know that you enjoy zebras, Errington, but the others that come to
mind  
(various parasites, including malaria of the brain) are almost unicorns
in the  
situation you mention.

ck
Charles S. Krin, DO FAAFP
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ccml RE: Old lady in MVC