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Thu May 10 07:00:25 BST 2007

Funny, but we do the exact opposite. Not many of our patients will  
lie still for a thorough exploration of the wound, and so what if  
there's penetration of the peritoneum. With the right population you  
still have over 50% chance of then performing a non-therapeutic  
laparotomy. It's the surgical equivalent of VOMIT!

We have a well-defined protocol for observation - really, is it so  
tough to examine someone once every couple of hours? Vital signs  
every couple of hours? Tenderness remote from the stab wound or vital  
signs outside our limits leads to exploration.

The key is a good protocol, will exclusion criteria well-defined.

Michael
On May 10, 2007, at 7:43 AM, Errington Thompson wrote:

> What is your comfort level?  I like wound explorations in patients  
> that will
> be still.  It doesn’t take long.  I can washout the wound and close  
> it in 15
> - 20 minutes.  The key seeing the whole wound.  You need good  
> lighting.  If
> you don't have that then go to the OR and do the same thing.  IN  
> the OR use
> your retractors see everything.  Don't guess. If the peritoneum is  
> violated
> open the patient.  If it isn't then close the wound and send the  
> patient
> home.
>
> Serial abdominal exams are labor intensive.  Would not use unless  
> you have
> residents and an excellent nursing staff.  Need to monitor these  
> patients.
>
> I use CT a lot in abdominal trauma but not really for evaluation of  
> the
> anterior abdomen with a penetrating wound.
>
> My 2 cents.
>
> 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 Abdullah Harthy
> Sent: Wednesday, May 09, 2007 9:40 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: stab wounds to anterior abdomen
>
> I was recently presenting a case scenario to a group
> of surgical residents, and we had a bit of a debate on
> how to manage pt.. with stab wound to the anterior
> abdomen (not in the cardiac box), hemodynamically
> stable, no peritonitis. Wound exploration, CT abdomen
> vs. serial abdominal exam.
> I'd like to know the group  practice is (considering a
> lot of our patients are intoxicated with one thing or
> another). I would also appreciate referrences if
> available. How low is your threshold for an
> explorative laprotomy.
>
> Abdullah Al- Harthy
>
>
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Michael J. Bayme, M.D., FACS
Soroka University Medical Center
Beer-Sheva, Israel

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