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Mon Sep 3 18:17:50 BST 2007

I agree. I too would not be happy with the ultimate quality of the CT and,
as per my last posting, would want therefore want an angiogram at this point
(with the hindsight of having now reviewed the images on a proper screen.)

I also agree with requesting a barium contrast study (for the reasons
mentioned in my posting on Friday - better quality, fewer false positives
and negatives than gastrograffin etc.) The one side effect of barium will be
countermanded easily by a washout (rapidly in the OR if a leak has been
demonstrated) versus the many reasons for not using gastrograffin. The 3-0
argument is a suitable way of putting the relevant issues into context. Here
is some anecdotal evidence on gastrograffin. Over the past week, 3
non-trauma patients have had gastrograffin studies in our hospital (2
swallow, 1 enema.) All demonstrated no leak. However, all 3 had leaks which
were missed on the study!

Sal, I still remained concerned regarding his chest drain output but have
not, as yet, been provided with further information that I require to enable
me to make a decision regarding this. There must clearly now be an ongoing
bleed in this thoracic cavity which needs addressing. I need further
information though in order for me to make an appropriate management
decision on this. What is his clotting and vital signs etc.?

Matthew

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GSW TO RIGHT CHEST. BARIUM CONTRAST STUDY PLEASE