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Thu Feb 14 17:11:13 GMT 2008

OH, THANK YOU, THANK YOU, Sal.
I would have had this kid in the angio suite PDQ (pretty damn quick) for angio/embo based solely on the exact point you raised -  "have you ever treated conservatively someone without a CT blush who failed conservative management".  I have the same tone that you do, and if I were afraid of any spleen failing conservative management, this would have to be one of those!

Ron

>>> <SJASMD at aol.com> 2/14/2008 10:37 AM >>>

In a message dated 2/14/2008 6:53:50 A.M. Eastern Standard Time,  
Rgross at harthosp.org writes:

Sal,
This image has no blush - but I wonder about the rest of the  scan.   Based 
ONLY on this image, would you have squirted this  kid?
Ron

ron

have you ever treated conservatively someone without a CT blush who failed  
conservative management? 

Based on the CT, I would definitely done an arteriogram, probably  within an 
hour. I know that this is considered overkill but my sphincter doesn't  
tighten anymore. 

Negative angio, successful nonoperative therapy
positive angio, plus proximal coiling, successful nonoperative  therapy

This strategy gives virtually no failure. Only requires sufficient  stability 
to allow CT. Failure of nonoperative therapy should be a sentinel  event. 

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CT confirmation of healing spleen