List Archives

Thu Jun 7 03:03:16 BST 2007

I'd watch it, serial H/H, probably wouldn't rescan,
wouldn't angio at present, if decompensates spleen
goes in bucket...

K
--- caesar ursic <cmursic at gmail.com> wrote:

> Actual current case of mine:
> 
> 15 yo male 'accidentally' tackled during spring
> football training (it was
> supposed to be a 'no-contact' practice session,
> but...oh well.. )  He said
> the blow 'knocked the wind out of me and hurt pretty
> bad."  He went home
> that afternoon feeling a bit 'weak' and tried to eat
> but could not.  Slept
> poorly due to pain in left upper abdomen/lower
> chest.  Next morning in more
> pain, so mom takes him to our ER.  He tells me his
> left upped belly hurts.
> He's not hungry even though he skipped dinner and
> breakfast.
> 
>  His vital signs on arrival:  BP 136/81   HR: 90  
> RR: 16   TEMP: 36.5
> 
> Exam: He looks pretty good, albeit worried.
> Skin: warm, well perfused,  No scleral icterus
> Lungs: Equal breath sounds.
> Chest: minimal tenderness over left lower anterior
> ribs
> Heart: Normal heart tones.
> Abdomen:  non-distended, no bruises,  bowel sounds
> present and normal.
> Tender in LUQ with some voluntary guarding; other
> areas of abdomen are
> NON-tender and soft.
> Back and spine are normal.
> Genitourinary exam: normal
> Rectal exam: normal
> 
> Hb: 13.9 g/dL (prior to any intravenous fluids). 
> WBC 17,000.  Serum amylase
> and lipase are normal.  T. Bili: 2.1.  ALT and AST:
> normal
> 
> urinalysis: grossly clear (i.e. no gross hematuria),
> microscopy shows 5-10
> RBCs per high-power-field.
> 
> CT scan of abdomen:  selected cuts
> here<http://trauma.homestead.com/spleen_ct.html>(
> http://trauma.homestead.com/spleen_ct.html).
> Remainder of abdominal CT shows
> NO pneumoperitoneum, NO liver/kidney/pancreatic
> injury, NO oral contrast
> extravasation, NO periduodenal fluid or thickened
> loops of intestine.  there
> is some fluid in the pelvis and around the lower
> liver.
> 
> Remember, this injury is now approx 18 hours old. 
> His BP on repeated
> determinations remains normal, and he is NOT
> tachycardic.
> 
> How would you manage this patient?  Next step(s)??
> 
> C. Ursic, MD
> Santa Fe
> USA
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