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Thu May 17 05:55:38 BST 2007

Roy

We have started doing routine Duplex Doppler on these patients, since it is fairly good at picking up intimal flaps - which is really the only injury in Z2 that clinical exam misses. If it detects a probable injury we do a formal angio in adults, but we all know that angio in children has much higher risks and that the incidence of major vascular injury is less under age 8. So one may probably be conservative here. A CTA would be another option.

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 Roy Danks
Sent: Thursday, May 17, 2007 6:06 AM
To: Trauma &amp; Critical Care mailing list
Subject: BCI

Here's the case scenario.  I'm really only interested in YES or NO answers based on the case.  I've read the literature.

A 4 y.o. wrecks her bike (?speed).  She strikes her right anterior neck, directly over the SCM groove, zone II, on the round end of the handle bar.  There is no LOC.  There is a hematoma, non-expanding, non-pulsatile, no bruit or thrill.  No neuro signs/symptoms at all.  But, there is a round "gouge" mark in the shape of the handle bar directly over the hematoma.

My question:  Do you screen for BCI using a CTA or other contrast study of your choice?  

I've reviewed the literature, but I'm interested to see how the list-serv members would evaluate this.

Thank you in advance.
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