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Tue Nov 27 20:36:48 GMT 2007

Thx for followup.   I have seen and consulted in several of these cases w "clot" at the IVC - R RA junction.   All cleared at next CT.    

K

Sent via BlackBerry by AT&T

-----Original Message-----
From: "Ronald Gross" <Rgross at harthosp.org>

Date: Tue, 27 Nov 2007 15:17:13 
To:"Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Subject: RE: Trauma case

WOW - you could make a movie......"VOMIT Gone Wild"

>>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/27/2007 2:27 PM >>>
Some follow-up on my young boy with the IVC clot. Nobody seems to be
able to figure out how to get the images off the PACS system so that I
can send them. I am not sure how motivated the radiologists are to
accommodate my request--given my conversations with them about this
case...
At any rate, a second follow up usd showed that the "clot" had
completely disappeared. Anticoagulation was stopped and the patient was
dc'ed. He is to follow up as an outpatient to get the IVC filter
removed. I hope this actually happens. Some of my colleagues have
criticized me for stopping the anticoagulation--they wanted a 3 month
course--mostly for medicolegal concerns. I just disagree--and had a long
talk to patient and family about this. Thanks to all for the input. 

Patrick J. Offner MD MPH
Chief, Surgical Critical Care
St Anthony Central Hospital

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Friday, November 23, 2007 12:58 PM
To: trauma-list at trauma.org 
Subject: RE: Trauma case

AW GEEZ Patrick - can you imagine what those guys are gonna do to this
poor kid if you are away for a whole weekend??????

Just pullin' yer leg, Pat.

Have a great weekend.

Ron

>>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/23/2007 1:47 PM >>>
It is retrievable--but as you know that doesn't always lead to removal.
I am still trying to get the images. I am off for the weekend now--so
may not be until Monday!  

________________________________

From: trauma-list-bounces at trauma.org on behalf of Ronald Gross
Sent: Fri 11/23/2007 11:20 AM
To: trauma-list at trauma.org 
Subject: RE: Trauma case

I didn't even want to ask!

>>> <rfsmithmd at comcast.net> 11/23/07 12:47 PM >>>
I don't suppose it was a removable filter

-------------- Original message --------------
From: "Ronald Gross" <rgross at harthosp.org>

> See Pat - this was all your fault. You should have NEVER TAKEN A DAY
OFF!!!!!
> ;-)
> Hang in there, my friend. You got caught up in this one just 'cause.
Looking
> forward to seeing those images, if at all possible.
>
> Take care,
> Ron
>
> >>> "Offner, Patrick" 11/22/07 11:47 PM >>>
> Thanks for your response. Trust me you are preaching to the choir--I
was
> one unhappy camper when I came to work and saw what had transpired. I
> now wish that I had cancelled all that nonsense when I had the chance.
I
> certainly don't use troponins or echos for blunt myocardial
> injury--unless there is some other factor(hemodynamic instability not
> responding to usual measures, elderly patient with concern for cardiac
> event leading to the injury, etc). I was even more unhappy with the
IVC
> filter placed in the usual infrarenal location=BELOW this supposed
> thrombus. And in a young patient. I want to stop the anticoagulation
> and pull the filter ASAP. I am concerned that these imaging studies
and
> their official dictations will come back to haunt me, though. I will
try
> to get the IVC ultrasound, gram and CT images off the server to send.
> Regarding the chest wall pain--I believe the patient sustained a
> significant hit to his chest wall and has a chest wall contusion or
rib
> fractures not apparent on plain film or CT. Thanks again.
>
> Pat
>
>
> Patrick J. Offner MD MPH
> Chief, Surgical Critical Care
> St Anthony Central Hospital
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
> Sent: Thursday, November 22, 2007 8:20 PM
> To: trauma-list at trauma.org 
> Subject: Re: Trauma case
>
> OOPS! Ken, I completely forgot the chest pain issue that sparked the
> whole workup!!
>
> >>> 11/22/2007 9:42 PM >>>
> 1st. He complained of left posterior chest wall pain and got a
> $200,000.00 workup for anterior and right chest issues. What
> ever happened to
> his left posterior chest wall pain??
>
> 2nd I am surprised that someone did not order a Cardiac Cath with
> stents and Plavix. Would have fit with the rest of the wild goose
> chases
>
> 3rd. I have seen the CT and Cavogram "shadow" of a presumed clot,
> which
> was GONE a week later on subsequent grams WITHOUT anticoagulation.
>
> 4th. Where was the IVC filter placed. If it was not ABOVE the
> supposed
> clot, it is inserted totally un necessarilly.
>
> 5th. Could you reporduce and send the cavogram of the clot? You
> have
> launched on a long term care, which in itself has very little evidence
> based
> support, on the cavogram alone.
>
> 6th. If I were the patient I would want to be OFF the coumadin
> today.
>
>
> k
>
>
>
>
>
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> 1)
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