SW to heart

• Previous message: trauma-list Digest, Vol 66, Issue 4
• Next message: SW to heart EMOTIONS and FACTS - HELLO
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

Tim,
When it is published, please send us the reference.
Take care,
Ron

-----Original Message-----
From: Dr Timothy Hardcastle <dr.tchardcastle at absamail.co.za>
Sent: Tuesday, December 02, 2008 1:08 PM
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Subject: RE: SW to heart


Errington

Occult esophagus injury in Z1 or 2 is not uncommon. CT is NOT yet good
enough to exclude an injury. A contrast swallow together with Angio or CTA
will exclude all injuries and enable non-op management if no significant
injury. If there are hard signs of a vascular injury explore for Z2, while
first image stable Z1's even with hard signs as endovasclar rx may be an
option.

See our study on the esophagus currently in-press EMJ - not sure which
issue it will be in. Basically we showed that an iso-oncotic swallow will
detect 100% of signficant abnormalities without the need for other
studies, except vascular injuries, which are approached either with
empiric Z1 imaging or clinical Z2 management.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
> Tim -
>
> Why the contrast swallow?
>
> Errington C. Thompson, MD
> Trauma/Surgical Critical Care
> Talk Show Host - WPEK
> www.whereistheoutrage.net
> Asheville, NC
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Dr Timothy Hardcastle
> Sent: Monday, December 01, 2008 2:14 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: SW to heart
>
> Errington
>
> I would explore the neck after a contrast swallow if positive or if hard
> signs and in zone 2. Otherwise would have observed both injuries.
>
> Tim
>
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer UKZN Dept Surgery
> Deputy Director - IALCH Trauma Service
>> Question - I had a gentleman who tried to end it all the other night.
>> He
>> had a SW (slash) to the neck and a single SW inside the cardiac box.
>> The
>> patient was hemodynamically stable.  CXR revealed a left effusion.  I
>> did
>> a
>> FAST in the ER then I CT of the chest with contrast.  My FAST was
>> negative
>> for pericardial fluid.  The CT was read as a small amount of fluid at
>> the
>> apex of the heart.  I took the patient to the OR and explored the neck
>> wound.  Left chest tube 500cc out then nothing.  Who would have explored
>> this patient's chest?
>>
>>
>>
>> Next morning the patient's heart rate was 100- 110.  BP 120/70.  Partner
>> takes the patient to the OR for a pericardial window.  It is positive.
>> Cardiac surgery finds a non-bleeding laceration to the left ventricle.
>> Who
>> would have taken this patient to the OR?
>>
>>
>>
>> Thoughts?
>>
>>
>>
>> Errington C. Thompson, MD, FACS, FCCM
>>
>> Trauma/Surgical Critical Care
>>
>> Talk Show Host - WPEK 880 AM
>>
>> Asheville, NC
>>
>> --
>> 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/
>
> --
> 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/
-----------------------------------------
CONFIDENTIALITY NOTICE: This email communication and any
attachments may contain confidential and privileged information for
the use of the designated recipients named above. If you are not
the intended recipient, you are hereby notified that you have
received this communication in error and that any review,
disclosure, dissemination, distribution or copying of it or its
contents is prohibited. If you have received this communication in
error, please reply to the sender immediately or by telephone at
(413) 794-0000 and destroy all copies of this communication and any
attachments. For further information regarding Baystate Health's
privacy policy, please visit our Internet web site at
http://www.baystatehealth.com.

• Previous message: trauma-list Digest, Vol 66, Issue 4
• Next message: SW to heart EMOTIONS and FACTS - HELLO
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]