List Archives

Thu May 10 17:31:43 BST 2007

Exploration under LA in alert patient. Peritoneal violation earns laparotomy. 

Patient loads in Pakistan do not allow the manpower and reliability for serial examinations (as I'm sure is the case in all developing countries). In any case ours is a safe protocol.

S Muzammil, FRCS
  ----- Original Message ----- 
  From: Tchaka Shepherd 
  To: trauma-list at trauma.org 
  Sent: Thursday, 10 May, 2007 11:28 AM
  Subject: Re: stab wounds to anterior abdomen

  Diagnostic laparoscopy is an extremely useful tool for the evaluation of penetrating trauma of the anterior abdominal wall.  If the exam is negative, patients can be discharged after routine postop recovery.  Guys it's 2007 not 1957.

                                                                                TS

  NOTHING  SPLENDID Has Ever Been Achieved Except By Those Who DARED BELIEVE THAT SOMETHING INSIDE THEM  Was Superior to CIRCUMSTANCE

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    From: Michael Bayme <mbayme at bgu.ac.il>
    Reply-To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
    To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
    Subject: Re: stab wounds to anterior abdomen
    Date: Thu, 10 May 2007 09:00:25 +0300
    >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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    >>
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    >
    >Michael J. Bayme, M.D., FACS
    >Soroka University Medical Center
    >Beer-Sheva, Israel
    >
    >
    >
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stab wounds to anterior abdomen