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McSwain, Norman E Jr. nmcswai at tulane.eduMon Dec 22 15:24:42 GMT 2008
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Do you have to observe for 24 hours? Is there any data to support that 6 hours is not enough. 24 hours in the ED produces an awful lot of congestion in an already overcrowded place Norman Norman McSwain MD Professor, Tulane School of Medicine Trauma Director, Charity Hospital Trauma Center norman.mcswain at tulane.edu 504 988 5111 -----Original Message----- From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Schulz, John Sent: Monday, December 22, 2008 9:15 AM To: trauma-list at trauma.org Subject: Re: airline incident I prefer to observe for 24 hours anyone who has had a significant inhalation exposure of smoke of any kind. It is rare for someone who has a stable airway and no dyspnea to develop a problem during that period of observation: that said, there is an occasional patient who develops difficulty. John T Schulz III, MD, PhD, FACS Associate Chairman, Department of Surgery Chief, Trauma/Burns/Surgical Critical Care Director, Andrew J Panettieri Burn Center Bridgeport Hospital 267 Grant Street Bridgeport, CT 203-384-3890 pjschu at bpthosp.org -----Original Message----- From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of trauma-list-request at trauma.org Sent: Monday, December 22, 2008 7:00 AM To: trauma-list at trauma.org Subject: trauma-list Digest, Vol 66, Issue 23 Send trauma-list mailing list submissions to trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit http://list.mistral.net/mailman/listinfo/trauma-list or, via email, send a message with subject or body 'help' to trauma-list-request at trauma.org You can reach the person managing the list at trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." Today's Topics: 1. Denver Airliner Incident (Richard Besserman, M.D., M.S., CHS-V) 2. Re: Stable pt w mesenteric extrav (Ben Reynolds) 3. Re: Stable pt w mesenteric extrav (Jane Harper) 4. Re: unstable pt with low GCS ( Ante ?ori? ) 5. RE: Denver Airliner Incident (McSwain, Norman E Jr.) 6. RE: Denver Airliner Incident (James Richardson) 7. Re: Denver Airliner Incident (KMATTOX at aol.com) 8. Re: Denver Airliner Incident (McSwain, Norman E Jr.) 9. Re: Stable pt w mesenteric extrav (Ben Reynolds) ---------------------------------------------------------------------- Message: 1 Date: Sun, 21 Dec 2008 10:56:10 -0700 From: "Richard Besserman, M.D., M.S., CHS-V" <emermgt at besserman.com> Subject: Denver Airliner Incident To: <trauma-list at trauma.org> Message-ID: <C573D14A.1273A%emermgt at besserman.com> Content-Type: text/plain; charset="ISO-8859-1" Burning/melting plastic and other composites give off toxic fumes that are known to cause immediate as well as delayed health affects. One of the serious issues is the development of delayed onset pulmonary edema. I read an account of ?dripping plastic? in the airline incident in Denver that occurred yesterday. Whether a victim experiences overt trauma or not, they may if the exposure was severe enough, develop delayed pulmonary edema that can be life threatening. I was taught that prolonged periodic observation and limited activity are recommended. Is anyone aware of whether that has happened in this incident? Any exposed person would be at risk even without overt traumatic injury. It might not be a good idea to let those who appear healthy to get on another flight right away. Does anyone have experience with these issues? Richard Besserman, M.D., M.S., CHS-V Emergency Management College of Technology and Innovation (602) 957-0101 emermgt at besserman.com Richard.Besserman at asu.edu ------------------------------ Message: 2 Date: Sun, 21 Dec 2008 10:26:30 -0800 (PST) From: Ben Reynolds <aneurysm_42 at yahoo.com> Subject: Re: Stable pt w mesenteric extrav To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <155894.50555.qm at web56607.mail.re3.yahoo.com> Content-Type: text/plain; charset=iso-8859-1 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 ? ? ? __________________________________________________________________ Ask a question on any topic and get answers from real people. Go to Yahoo! Answers and share what you know at http://ca.answers.yahoo.com -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ------------------------------ Message: 3 Date: Sun, 21 Dec 2008 12:30:23 -0600 From: Jane Harper <janeharper at mac.com> Subject: Re: Stable pt w mesenteric extrav To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <C573E75F.1DFC2%janeharper at mac.com> Content-Type: text/plain; charset=ISO-8859-1 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 > BMI>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 > > > ? ? ? > __________________________________________________________________ > Ask a question on any topic and get answers from real people. Go to Yahoo! > Answers and share what you know at http://ca.answers.yahoo.com > -- > 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/ -- Jane Harper, PhD(c), RN, APN Trauma Nurse Practitioner, Rockford, IL ------------------------------ Message: 4 Date: Sun, 21 Dec 2008 20:18:26 +0100 From: " Ante ?ori? " <ante.coric85 at gmail.com> Subject: Re: unstable pt with low GCS To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <edddfb3e0812211118t308f8935vd73a21d0f67994e4 at mail.gmail.com> Content-Type: text/plain; charset=ISO-8859-1 hope for the best 2008/12/21 khumar huseynova <khumarhuse at yahoo.ca> > Intra-op head CT is a luxury that we cant afford here yet. Sounds very > advanced! > > The indication for the bone flap was to reduce the ICP given that the > pt had injuries management of which contradicted each other (CHI and > thoracic aortic PSA). Currently his LOC fluctuates with days when he > is able to obey commands and those when he doesnt. > > K > > > > __________________________________________________________________ > Yahoo! Canada Toolbar: Search from anywhere on the web, and bookmark your > favourite sites. Download it now at > http://ca.toolbar.yahoo.com. > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > ------------------------------ Message: 5 Date: Sun, 21 Dec 2008 13:49:35 -0600 From: "McSwain, Norman E Jr." <nmcswai at tulane.edu> Subject: RE: Denver Airliner Incident To: "Trauma &" <trauma-list at trauma.org> Message-ID: <B79C02DCC4FA074DB02381DF1C5D60BA01D280FC at EX07.ad.tulane.edu> Content-Type: text/plain; charset="iso-8859-1" I was on trauma call yesterday and last night. Just got home a while ago. We were busy and I did not hear of the incident. What are the details? Norman Norman McSwain MD Trauma Director, Charity Hospital Professor of Surgery, Tulane University New Orleans LA 504 988 5111 norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> ________________________________ From: trauma-list-bounces at trauma.org on behalf of Richard Besserman, M.D., M.S., CHS-V Sent: Sun 12/21/2008 11:56 AM To: trauma-list at trauma.org Subject: Denver Airliner Incident Burning/melting plastic and other composites give off toxic fumes that are known to cause immediate as well as delayed health affects. One of the serious issues is the development of delayed onset pulmonary edema. I read an account of ?dripping plastic? in the airline incident in Denver that occurred yesterday. Whether a victim experiences overt trauma or not, they may if the exposure was severe enough, develop delayed pulmonary edema that can be life threatening. I was taught that prolonged periodic observation and limited activity are recommended. Is anyone aware of whether that has happened in this incident? Any exposed person would be at risk even without overt traumatic injury. It might not be a good idea to let those who appear healthy to get on another flight right away. Does anyone have experience with these issues? Richard Besserman, M.D., M.S., CHS-V Emergency Management College of Technology and Innovation (602) 957-0101 emermgt at besserman.com Richard.Besserman at asu.edu -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ -------------- next part -------------- A non-text attachment was scrubbed... Name: not available Type: application/ms-tnef Size: 5081 bytes Desc: not available URL: <http://list.mistral.net/pipermail/trauma-list/attachments/20081221/26c6 ec86/attachment-0001.bin> ------------------------------ Message: 6 Date: Sun, 21 Dec 2008 12:53:03 -0700 From: "James Richardson" <jimmnn at comcast.net> Subject: RE: Denver Airliner Incident To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org> Message-ID: <036101c963a5$bdb306f0$391914d0$@net> Content-Type: text/plain; charset="iso-8859-1" http://www.9news.com/news/article.aspx?storyid=106332 <http://www.9news.com/news/article.aspx?storyid=106332&catid=339> &catid=339 Most patients have been discharged. Jim< From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr. Sent: Sunday, December 21, 2008 12:50 PM To: Trauma & Subject: RE: Denver Airliner Incident I was on trauma call yesterday and last night. Just got home a while ago. We were busy and I did not hear of the incident. What are the details? Norman Norman McSwain MD Trauma Director, Charity Hospital Professor of Surgery, Tulane University New Orleans LA 504 988 5111 <mailto:norman.mcswain at tulane.edu> norman.mcswain at tulane.edu _____ From: trauma-list-bounces at trauma.org on behalf of Richard Besserman, M.D., M.S., CHS-V Sent: Sun 12/21/2008 11:56 AM To: trauma-list at trauma.org Subject: Denver Airliner Incident Burning/melting plastic and other composites give off toxic fumes that are known to cause immediate as well as delayed health affects. One of the serious issues is the development of delayed onset pulmonary edema. I read an account of ?dripping plastic? in the airline incident in Denver that occurred yesterday. Whether a victim experiences overt trauma or not, they may if the exposure was severe enough, develop delayed pulmonary edema that can be life threatening. I was taught that prolonged periodic observation and limited activity are recommended. Is anyone aware of whether that has happened in this incident? Any exposed person would be at risk even without overt traumatic injury. It might not be a good idea to let those who appear healthy to get on another flight right away. Does anyone have experience with these issues? Richard Besserman, M.D., M.S., CHS-V Emergency Management College of Technology and Innovation (602) 957-0101 emermgt at besserman.com Richard.Besserman at asu.edu -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ -------------- next part -------------- A non-text attachment was scrubbed... Name: winmail.dat Type: application/ms-tnef Size: 7114 bytes Desc: not available URL: <http://list.mistral.net/pipermail/trauma-list/attachments/20081221/a910 7496/attachment-0001.bin> ------------------------------ Message: 7 Date: Sun, 21 Dec 2008 14:56:11 EST From: KMATTOX at aol.com Subject: Re: Denver Airliner Incident To: trauma-list at trauma.org Message-ID: <c76.3b12948c.367ff95b at aol.com> Content-Type: text/plain; charset="ISO-8859-1" The plane got up to speed and was going down the runway and apparently had some stability problems and slid off the runway. NO ICE or SNOW. Slid into a Revene and broke wing and fuscaliage. Engine and wing caught on fire. Left wing. People got out the emergency exits on the RIGHT, Some bruises and broken bones. No burns. In a message dated 12/21/2008 1:50:53 P.M. Central Standard Time, nmcswai at tulane.edu writes: I was on trauma call yesterday and last night. Just got home a while ago. We were busy and I did not hear of the incident. What are the details? Norman Norman McSwain MD Trauma Director, Charity Hospital Professor of Surgery, Tulane University New Orleans LA 504 988 5111 norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> ________________________________ From: trauma-list-bounces at trauma.org on behalf of Richard Besserman, M.D., M.S., CHS-V Sent: Sun 12/21/2008 11:56 AM To: trauma-list at trauma.org Subject: Denver Airliner Incident Burning/melting plastic and other composites give off toxic fumes that are known to cause immediate as well as delayed health affects. One of the serious issues is the development of delayed onset pulmonary edema. I read an account of ?dripping plastic? in the airline incident in Denver that occurred yesterday. Whether a victim experiences overt trauma or not, they may if the exposure was severe enough, develop delayed pulmonary edema that can be life threatening. I was taught that prolonged periodic observation and limited activity are recommended. Is anyone aware of whether that has happened in this incident? Any exposed person would be at risk even without overt traumatic injury. It might not be a good idea to let those who appear healthy to get on another flight right away. Does anyone have experience with these issues? Richard Besserman, M.D., M.S., CHS-V Emergency Management College of Technology and Innovation (602) 957-0101 emermgt at besserman.com Richard.Besserman at asu.edu -- 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/ **************One site keeps you connected to all your email: AOL Mail, Gmail, and Yahoo Mail. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom0 0000025) ------------------------------ Message: 8 Date: Sun, 21 Dec 2008 14:00:58 -0600 From: "McSwain, Norman E Jr." <nmcswai at tulane.edu> Subject: Re: Denver Airliner Incident To: <trauma-list at trauma.org> Message-ID: <B79C02DCC4FA074DB02381DF1C5D60BA0168EEB0 at EX07.ad.tulane.edu> Content-Type: text/plain; charset="UTF-8" Thanks Typed by the thumbs of Norman on his BlackBerry Norman McSwain, MD Tulane Univ Surgery 504 988-5111 ----- Original Message ----- From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org> To: trauma-list at trauma.org <trauma-list at trauma.org> Sent: Sun Dec 21 13:56:11 2008 Subject: Re: Denver Airliner Incident The plane got up to speed and was going down the runway and apparently had some stability problems and slid off the runway. NO ICE or SNOW. Slid into a Revene and broke wing and fuscaliage. Engine and wing caught on fire. Left wing. People got out the emergency exits on the RIGHT, Some bruises and broken bones. No burns. In a message dated 12/21/2008 1:50:53 P.M. Central Standard Time, nmcswai at tulane.edu writes: I was on trauma call yesterday and last night. Just got home a while ago. We were busy and I did not hear of the incident. What are the details? Norman Norman McSwain MD Trauma Director, Charity Hospital Professor of Surgery, Tulane University New Orleans LA 504 988 5111 norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> ________________________________ From: trauma-list-bounces at trauma.org on behalf of Richard Besserman, M.D., M.S., CHS-V Sent: Sun 12/21/2008 11:56 AM To: trauma-list at trauma.org Subject: Denver Airliner Incident Burning/melting plastic and other composites give off toxic fumes that are known to cause immediate as well as delayed health affects. One of the serious issues is the development of delayed onset pulmonary edema. I read an account of ?dripping plastic? in the airline incident in Denver that occurred yesterday. Whether a victim experiences overt trauma or not, they may if the exposure was severe enough, develop delayed pulmonary edema that can be life threatening. I was taught that prolonged periodic observation and limited activity are recommended. Is anyone aware of whether that has happened in this incident? Any exposed person would be at risk even without overt traumatic injury. It might not be a good idea to let those who appear healthy to get on another flight right away. Does anyone have experience with these issues? Richard Besserman, M.D., M.S., CHS-V Emergency Management College of Technology and Innovation (602) 957-0101 emermgt at besserman.com Richard.Besserman at asu.edu -- 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/ **************One site keeps you connected to all your email: AOL Mail, Gmail, and Yahoo Mail. Try it now. (http://www.aol.com/?optin=new-dp&icid=aolcom40vanity&ncid=emlcntaolcom0 0000025) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ------------------------------ Message: 9 Date: Sun, 21 Dec 2008 13:27:47 -0800 (PST) From: Ben Reynolds <aneurysm_42 at yahoo.com> Subject: Re: Stable pt w mesenteric extrav To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> Message-ID: <158701.20727.qm at web56603.mail.re3.yahoo.com> Content-Type: text/plain; charset=iso-8859-1 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 > BMI>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 > > > ? ? ? > __________________________________________________________________ > Ask a question on any topic and get answers from real people. Go to Yahoo! > Answers and share what you know at http://ca.answers.yahoo.com > -- > 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/ -- Jane Harper, PhD(c), RN, APN Trauma Nurse Practitioner, Rockford, IL -- 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/ End of trauma-list Digest, Vol 66, Issue 23 ******************************************* -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/
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