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Mon Dec 22 22:30:36 GMT 2008

Not to be picky, but the CDC actually defines morbid obesity as a BMI of > 40 kg/m2, or a BMI of > 35 kg/m2 with significant comorbidities.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jane Harper
Sent: Sunday, December 21, 2008 1:30 PM
To: Trauma &amp; Critical Care mailing list
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