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Wed Feb 14 16:27:46 GMT 2007

Tim - 

Interesting thought.  I'm not sure that the data supposes being as
aggressive as you are.  This patient didn't have a seat belt mark on her
neck and no loss of consciousness.  We didn't identify any neck trauma. 

Thanks, 

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

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>
Sent: Tuesday, February 13, 2007 11:48 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: FW: Old lady in MVC

Rob / Errington et al

Blunt carotid injury with intimal flap typically causes a stroke after 48
hours - one of the reasons we screen all blunt neck soft-tissue traumas with
a Duplex Doppler.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Robert Smith
Sent: Tuesday, February 13, 2007 6:21 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: FW: Old lady in MVC

In David Livingston's most excellent paper I believe the patients that had
"only free fluid" were absolutely pristine except for that finding. No
hypotension plus free fluid. Though it's hard to improve on "stable", she
had already had a few episodes of hypotension without a known cause. Old
folks lack the physiologic reserve that we're used to dealing with and who
knows if she would bounce back from the next episode if there was one.

Confusion post trauma. Hmmm. She's now a few days out right? One would think
a structural lesion would have manifested itself sooner, so it might not be
because of trauma. On the other hand if she showed up in the ED with
confusion as her chief complaint everyone would get a CT.

Rob Smith

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FW: Old lady in MVC