List Archives

Thu May 10 13:45:35 BST 2007

Tim,

Would you observe patients with omental evisceration that have a completely
benign abdomen? After reducing the omentum back in. 

Or is this a different group of patients that will have a lower rate of
therapeutic laparotomy and therefpre should be explored every time?

E Daza

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>
Sent: Thursday, May 10, 2007 8:37 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: stab wounds to anterior abdomen

Agree 100%
Maybe if you are in a centre that sees less than say 20 cases of abdominal
penetrating trauma per annum, you should do routine laparotomy, otherwise
observation is the way to go!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Michael Bayme
Sent: Thursday, May 10, 2007 8:00 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: stab wounds to anterior abdomen

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
>
>
>       Get news delivered with the All new Yahoo! Mail.  Enjoy RSS  
> feeds
> right on your Mail page. Start today at
> http://mrd.mail.yahoo.com/try_beta?.intl=ca
> --
> 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/

Michael J. Bayme, M.D., FACS
Soroka University Medical Center
Beer-Sheva, Israel

--
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/

List Archives

For your convenience, find the Trauma List Archive Below

stab wounds to anterior abdomen