List Archives

Tue Sep 4 17:23:53 BST 2007

Haim, Matthew and Ken

We are all in agreement that this case is not going in the direction we would have taken it. 

By the end of the one negative rigid esophaogoscopy, one equivocal flexible eseophagogoscopy?and bronchoscopy, ?his chest tube output had continued to a level that warranted operation. He then underwent right thoracotomy which revealed bleeding from the through and through lung laceration. This was managed by stapling the tract closed with hemostasis. Two chest tubes were left in. 

He then went to? a small GI fluoroscopy room one floor away from the OR (despite having an angiography suite next door to the trauma OR) where a gastrograffin esophagogram was performed. You will note that the gastrograffin is aspirated but the airway was protected by the endotracheal tube.

I have attached it for your review

He is then transported BACK to the OR

what to do now

sal

-----Original Message-----
From: Matthew Reeds <mgreeds at reeds.uk.com>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 3 Sep 2007 1:17 pm
Subject: GSW TO RIGHT CHEST. BARIUM CONTRAST STUDY PLEASE

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

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

________________________________________________________________________
Email and AIM finally together. You've gotta check out free AOL Mail! - http://mail.aol.com
-------------- next part --------------
A non-text attachment was scrubbed...
Name: 1619525_040 9-4-2007.jpg
Type: image/pjpeg
Size: 40440 bytes
Desc: not available
Url : http://list.mistral.net/pipermail/trauma-list/attachments/20070904/f7c7627a/1619525_0409-4-2007.bin

List Archives

For your convenience, find the Trauma List Archive Below

GSW TO RIGHT CHEST. IT GETS WORSE