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Mon Dec 22 23:06:21 GMT 2008

For a MCI, the ED is not necessarily the right place to observe.  USAMRIUCD
suggests that exposed asymptomatic people be periodic triaged.  The duration
of varies with the type of chemical.  Of the many possible exposures, oxides
of nitrogen cause delayed problems up to 72 hours whereas most other
chemicals will cause problems within the first 24 hours.  The more severe
the exposure the shorter the time for symptoms to arise.  The NIH web site
has an article that provides some valuable information on the subject:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2396464

Richard Besserman, M.D., M.S., CHS-V
Emergency Management
College of Technology and Innovation
(602) 957-0101
Richard.Besserman at asu.edu

On 12/22/08 8:24 AM, "McSwain, Norman E Jr." <nmcswai at tulane.edu> wrote:

> 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
> 
> 
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> 
> 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 &amp; 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
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> 
> 
> ------------------------------
> 
> 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 &amp; 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/

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