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Thu May 17 06:06:45 BST 2007

Tim,

Thank you.  I kicked around the duplex too, but settled for the CTA.  I saw an unfortunate case of a missed injury in a youngster on one of my trauma rotations as a resident.  Hockey puck to the neck.  Probably a higher velocity injury, but who knows.  I just picture this kid hitting the bar and that carotid stretching...and the kid stroking 18 hrs later.  As I said, I've read the literature.  There is no gold standard, if any standard exists at all.  I'm not one for "over kill" evaluation, but this is one I wouldn't want to miss...it's a life time of anguish for all involved.

I did the CTA, it was negative.  I'll sleep better tonight.

Thanks for your thoughtful input.

RD

> Date: Thu, 17 May 2007 06:55:38 +0200> From: tch at sun.ac.za> To: trauma-list at trauma.org> Subject: RE: BCI> > 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.> _________________________________________________________________> Create the ultimate e-mail address book. Import your contacts to Windows Live Hotmail.> www.windowslive-hotmail.com/learnmore/managemail2.html?locale=en-us&ocid=TXT_TAGLM_HMWL_reten_impcont_0507--> 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/
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