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Sat Mar 17 15:57:47 GMT 2007

Dear Tom,

Ah, but you would be wrong.  I was asked by the trauma service to consult on the patient.  I am a general/trauma surgeon, and do most of the thoracic work for our trauma service.  I did the consult, explained everything to the pt and his wife in detail and scheduled the VATS for the next day.

His oncologist is on board and I think he scared the patient into thinking: 1) VATS may "spread" tumor from the lung 2) wounds won't heal due to chemotherapy and 3) a cardiothoracic surgeon should be consulted for a second opinion.  They opted for the second opinion and that surgeon said he wouldn't do anything.  So, they (pt and his wife) decided not to do so.  

On the contrary, the patient had decided, well before the injury, to take the cancer bull by the horns.  Grim prognosis, yes, but no reason for him to give up hope and neither would I as his surgeon.

I am very straight forward with patients about what my plans are.  I speak at their level and explain things very clearly...using illustrations if necessary. They are getting mixed messages from a thoracic surgeon who, while a great guy and good surgeon, is a poor communicator and an oncologist who has over-stepped his boundries with what he thinks he knows about thoracic trauma (nothing).

You have complete info.  My feeling, and it's in my consult, is that evacuation of the retained clot and air is standard of care.  Some might argue.  He's a healthy looking guy...doesn't look washed out from the CA or the chemo.  I think he would do well with a VATS...in fact, I think he'd be on his way out of the hospital in a day or two.

Thanks,

RD

> Date: Sat, 17 Mar 2007 10:21:02 -0300> From: thoran at sarah.br> To: trauma-list at trauma.org> Subject: RE: (no subject)> > Dear dr danks,> > clearly your decision to ask this question suggests a patient whom you believe is at the end of care; otherwise you would have already replaced a non functioning tube with an appropriately placed one, taken a chest x ray the day following and booked his VATS if still unsuccessful. What motivates you to abandon the normal care in a patient who has limited useful time and who may want to return to his home as quickly as possible instead of being confined to hospital while his doctor dithers?> Tom> > > ----------> > From: trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of Roy Danks[SMTP:roydanks at hotmail.com]> > Reply To: Trauma &amp; Critical Care mailing list> > Sent: sexta-feira, 16 de março de 2007 20:21> > To: trauma-list at trauma.org> > Subject: (no subject)> > > > 63 y.o. male falls in bathtub and has multiple, displaced left rib fx, hemopneumothorax. Also has fairly recent dx of Stage IV colon CA (mets to lung and liver)...mets in the affected (traumatized lung). Now 8 days post injury and has retrained HTX (probably 300-500 ml...who knows, it's compressing and causing atelectasis, but no hypoxemia)...and about 15% PTX. Chest tube not in good position really.> > > > Do I: Replace the chest tube? Do a VATS, evac the clot and place chest tube(s) then or do nothing and see what happens?> > > > Thanks.> > > > R. Danks> > _________________________________________________________________> > Your friends are close to you. Keep them that way.> > http://spaces.live.com/signup.aspx--> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > http://www.trauma.org/index.php?/community/> > > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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VATS?