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Fri Jun 8 00:20:17 BST 2007

Hi Caeser
You know what we would say here at the Kids - bedrest, observation and
analgesia, especially after 18+ hrs. His physical exam appears ok and
vitals within limits
We see a number of these kids and most of the time the above is what we
do, these days we rarely go to Op Suite for a spleenectomy due to injury
(unless of course for medical reasons or a GrV injury - yes we have
non-operatively managed some GrIV), and they do well. No contact sport
for up to 8weeks and follow up in clinics 

Cheers
Fiona E Fahy
Trauma CNC
Dept. of Academic Surgery
Surgical Unit, L2
Children's Hospital Westmead
Locked Bag 4001
Westmead NSW 2145

Message: 4
Date: Wed, 6 Jun 2007 19:57:06 -0600
From: "caesar ursic" <cmursic at gmail.com>
Subject: the modern spleen
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
	<7d3839570706061857x4c55b96ifa31ae8367967877 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1; format=flowed

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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