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Thu May 17 12:27:33 BST 2007

OK - so disregard my earlier post - you just gave me my answer.

Be well, 
Ron

>>> Roy Danks <roydanks at hotmail.com> 5/17/2007 1:06 AM >>>
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.>
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