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Mon Mar 19 16:16:25 GMT 2007

300 to 500 cc should only occupy the costophrenic angle and that should not
restrict the lung.  Atlectasis is probably secondary to the contusion and
decreased inspiratory effort associated with the pain from the fractured
ribs.  I agree with VATS for evacuation of the hemothorax.  10 days out,
tube thorocostomy would only be expected to evacuate the PTX not the clotted
blood. At this point,if in fact the patient is not symptomatic I would
obtain a pain consult and discharge home with the appropriate pain meds.  

-----Original Message-----
From: Tchaka Shepherd [mailto:tshepherdmd at hotmail.com] 
Sent: Saturday, March 17, 2007 3:23 PM
To: trauma-list at trauma.org
Subject: RE: (no subject)

VATS will quickly get this terminally ill patient back home to friends and 
family.

<html><div>NOTHING&nbsp; SPLENDID Has Ever Been Achieved Except By Those Who

DARED BELIEVE THAT SOMETHING INSIDE THEM&nbsp; Was Superior to 
CIRCUMSTANCE</div></html>

>From: Roy Danks <roydanks at hotmail.com>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: <trauma-list at trauma.org>
>Subject: (no subject)
>Date: Fri, 16 Mar 2007 17:21:37 -0600
>
>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
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