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Sun Dec 21 21:27:47 GMT 2008

You are kind to inform me, Jane.  I'll try to remember that.

Ben Reynolds, PA-C
Pittsburgh, PA

________________________________
From: Jane Harper <janeharper at mac.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Sunday, December 21, 2008 1:30:23 PM
Subject: Re: Stable pt w mesenteric extrav

Just FYI, "morbid" obesity is defined as a BMI > 40, not 30.

Jane

On 12/21/08 12:26, "Ben Reynolds" <aneurysm_42 at yahoo.com> wrote:

> While I don't think any will argue that a laparotomy on a morbidly obese
> person can be fraught with technical problems as well as higher than normal
> rates of postoperative complications, the hollow viscus thickening described
> on CT in combination makes one worry more about devitalized intestine less
> than hemorrhage making me believe that you can't help but operate.  If this
> were a smaller sized person, I'd probably say operate, with impunity. 
> 
> But if the questions is 'how can we safely avoid an operation' I guess I would
> ask, given that he is 5-6 hours post trauma:
> 
> 1.  Do the areas of splenic flexure / small bowel thickening enhance on CT?
> 2.  Any melena?  Guiac positive?
> 3.  Hemoglobin / base deficit after resuscitation?  Serially?
> 4.  Most importantly what is his abdominal exam?
> 
> Ben Reynolds, PA-C
> Pittsburgh, PA
> 
> 
>  
> 
> 
> 
> ________________________________
> From: khumar huseynova <khumarhuse at yahoo.ca>
> To: Trauma Trauma <trauma-list at trauma.org>
> Sent: Saturday, December 20, 2008 9:29:30 PM
> Subject: Stable pt w mesenteric extrav
> 
> Another case we saw 2 days ago:
>  
> 67M post-MVA single rollover, brought to us about 5-6hrs post-accident.
> BMI>30. Stable vitals, GCS=14-15. CT abdo showed segmental SB and splenic
> flexure thickening with active but completely contained in the LUQ extrav from
> the mesenetery. Very small amount of FF in the pelvis, no other injuries, no
> FA.
> Anyone have experience with embolization of mesenteric branches after checking
> for collaterals during angio? Or would u take him to OR solely based on CT
> findings even if the hematoma/extrav was very small and contained?
>  
> K
> 
> 
>       __________________________________________________________________
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-- 
Jane Harper, PhD(c), RN, APN
Trauma Nurse Practitioner, Rockford, IL

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Stable pt w mesenteric extrav