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For your convenience, find the Trauma List Archive Below

Postmortem data

Sanjay Gupta MD sanjaygupta99_91 at yahoo.com
Fri Feb 29 00:33:20 GMT 2008 

Did it really happen?  Was an esophageal intubation
really discovered post-mortem on a CATopsy?  If you
have the picture, I would like to see it.  I must
submit that I have never seen that!! 



Sanjay







--- Stephen Richey <stephen.richey at gmail.com> wrote:

> The discussion of the CT autopsy article made me
> think of something.  If any
> of the trauma professionals here has access to data
> on those who survived to
> hospital admission following aircraft crashes
> (including planes,
> helicopters, ultralights, hot air balloons,
> gyrocopters, etc) please let me
> know.  I would be willing to partner with anyone
> necessary to gain access to
> the information.  Currently I am working on a
> database of fatal aviation
> data and would like to expand this and develop a
> comparable database for
> non-fatal injury resulting from aircraft crashes. 
> Please feel free to
> contact me off list to discuss further if anyone is
> interested.
> 
> 
> Steve
> 
> On Tue, Feb 26, 2008 at 7:01 AM,
> <trauma-list-request at trauma.org> wrote:
> 
> > 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. RE: trauma-list Digest, Vol 56, Issue 28
> (Sise, Mike MD)
> >   2. From the sound of it, C-1 fracture, OAD or
> the like.
> >      (Ronald Gross)
> >   3. "CATopsy" - postmortem CT. (Ivan Hronek)
> >   4. RE: "CATopsy" - postmortem CT. (Howard
> Berkowitz)
> >   5. RE: (no subject) (Anthony Caruso)
> >   6. Re: "CATopsy" - postmortem CT. (Ronald Gross)
> >   7. Re: cause of hypotension in shock/trauma
> (aktham yaghi)
> >   8. RE: (no subject) (Ronald Gross)
> >   9. RE: trauma-list Digest, Vol 56, Issue 28
> (William Bromberg)
> >  10. Re: "CATopsy" - postmortem CT. (Ivan Hronek)
> >  11. etiology of bradycardia in spinal (Ivan
> Hronek)
> >  12. Re: "CATopsy" - postmortem CT. (Ronald Gross)
> >
> >
> >
>
----------------------------------------------------------------------
> >
> > Message: 1
> > Date: Mon, 25 Feb 2008 04:50:18 -0800
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> > To: trauma-list at trauma.org
> > Message-ID:
> >       
>
<FEECA018557C774EB876F0D3BCB54E1B01103A9D at MSG02.corp.scripps.org>
> > Content-Type: text/plain; charset="iso-8859-1"
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > 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..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> > -------------- next part --------------
> > A non-text attachment was scrubbed...
> > Name: not available
> > Type: application/ms-tnef
> > Size: 4305 bytes
> > Desc: not available
> > Url :
> >
>
http://list.mistral.net/pipermail/trauma-list/attachments/20080225/31826af2/attachment-0001.bin
> >
> > ------------------------------
> >
> > Message: 2
> > Date: Mon, 25 Feb 2008 08:17:00 -0500
> > From: "Ronald Gross" <rgross at harthosp.org>
> > Subject: From the sound of it, C-1 fracture, OAD
> or the like.
> > To: <trauma-list at trauma.org>
> > Message-ID:
> <47C2797C020000B90001AB45 at gwmail6.harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > >From the sound of it, C-1 fracture, OAD or the
> like.
> >
> > And the answer is???
> >
> > Ron
> >
> >
> > ------------------------------
> >
> > Message: 3
> > Date: Mon, 25 Feb 2008 06:26:09 -0800 (PST)
> > From: Ivan Hronek <ivanhronek at yahoo.com>
> > Subject: "CATopsy" - postmortem CT.
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <924576.98806.qm at web62305.mail.re1.yahoo.com>
> > Content-Type: text/plain; charset=us-ascii
> >
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext  |  PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > 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..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > -----Inline Attachment Follows-----
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > 
>
____________________________________________________________________________________
> > Be a better friend, newshound, and
> > know-it-all with Yahoo! Mobile.  Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> >
> >
> > ------------------------------
> >
> > Message: 4
> > Date: Mon, 25 Feb 2008 09:37:57 -0500
> > From: Howard Berkowitz <hcberkowitz at hotmail.com>
> > Subject: RE: "CATopsy" - postmortem CT.
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <BAY116-W29F86799CB89D27DC0DCFA5180 at phx.gbl>
> > Content-Type: text/plain; charset="iso-8859-1"
> >
> >
> >
> > Hmmm. In principle, it seems a good idea. Assuming
> the institution pays
> > the costs, is there a requirement for consent from
> next of kin?
> >
> > > Date: Mon, 25 Feb 2008 06:26:09 -0800
> > > From: ivanhronek at yahoo.com
> > > To: trauma-list at trauma.org
> > > Subject: "CATopsy" - postmortem CT.
> > >
> > > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > > We rarely are allowed to do any autopsies and
> then when the results come
> > 8 months later noone remembers the case anymore.
> > >
> > > Fulltext  |  PDF (558 K)
> > > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> > >
> > > Original Articles
> > > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > > Abstract:
> > > Background: The autopsy remains the gold
> standard for evaluating
> > traumatic deaths. The number of autopsies
> performed has declined
> > dramatically. This study examines whether
> postmortem computed tomography
> > ("CATopsy") can be used to determine cause of
> death in trauma patients.
> > > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > > Conclusion: This study suggests that a
> postmortem imaging test, a
> > CATopsy, can be used to determine cause of death
> in trauma patients. Beyond
> > offering a noninvasive alternative to autopsy, it
> provides similar
> > information to that provided in postmortem
> examination and may be used in
> > trauma performance improvement activities.
> > >
> > > Ivan Hronek MD
> > > SFMC, Los Angeles
> > > cell: 310 487-3288
> > >
> http://health.groups.yahoo.com/group/Anesthideas/
> > > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > > Maharishi Mahesh Yogi
> > >
> > >
> > >
> > > Confidentiality Notice: This transmission and
> any attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ----- Original Message ----
> > > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > > To: trauma-list at trauma.org
> > > Sent: Monday, February 25, 2008 4:50:18 AM
> > > Subject: RE: trauma-list Digest, Vol 56, Issue
> 28
> > >
> > > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> > >
> > > Mike Sise
> > > San Diego
> > >
> > > ________________________________
> > >
> > > From: trauma-list-bounces at trauma.org on behalf
> of
> > trauma-list-request at trauma.org
> > > Sent: Mon 2/25/2008 4:00 AM
> > > To: trauma-list at trauma.org
> > > Subject: trauma-list Digest, Vol 56, Issue 28
> > >
> > >
> > >
> > > 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..."
> > >
> > >
> > >
> > > "Scripps Information Security"
> > >
> >
>
------------------------------------------------------------------------------
> > > This e-mail and any files transmitted with it
> may contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> > >
> > >
> > >
> >
>
==============================================================================
> > >
> > >
> > >
> > > -----Inline Attachment Follows-----
> > >
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
> > >
> >
>
____________________________________________________________________________________
> > > Be a better friend, newshound, and
> > > know-it-all with Yahoo! Mobile.  Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> >
> >
>
_________________________________________________________________
> > Climb to the top of the charts! Play the word
> scramble challenge with star
> > power.
> >
>
http://club.live.com/star_shuffle.aspx?icid=starshuffle_wlmailtextlink_jan
> >
> > ------------------------------
> >
> > Message: 5
> > Date: Mon, 25 Feb 2008 09:42:52 -0500
> > From: Anthony Caruso <medic541 at hotmail.com>
> > Subject: RE: (no subject)
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <BAY141-W32B572C07908CF7FD31DC99180 at phx.gbl>
> > Content-Type: text/plain; charset="iso-8859-1"
> >
> >
> > Just curious, but do these patients with cord
> compromise respond well to
> > certain types of catecholamine infusions????
> >
> > Anthony Caruso EMT-P
> >
> >
> >
> > > From: KMATTOX at aol.com> Date: Sun, 24 Feb 2008
> 22:09:22 -0500> To:
> > trauma-list at trauma.org; RUTLEDGELEGALRN at aol.com>
> CC: > Subject: Re: (no
> > subject)> > Which case are you referring to
> specifically. We now know that >
> > prehospital fluids more times than not are a
> DETRIMENT to survival. You do
> > not usually > "but time" by infusing fluids,
> unless the BP is below 50/- and
> > one cannot > feel a peripheral pulse. If there is
> a pericardial tear, then
> > change in > position is a better option than
> giving fluids and drugs in the
> > ambulance. > AND paramedics should most of the
> time NOT put tubes and
> > needles into a > chest. . I feel more strongly
> AGAINST interosseous needles
> > in the EMS setting. > > > k> > > In a message
> dated 2/24/2008 9:01:18 P.M.
> > Central Standard Time, > RUTLEDGELEGALRN at aol.com
> writes:> > This case
> > fascinates me. Would the initial resusitation with
> IVF's buy time > > as it
> > appears happened in this patient's case, in the
> events you describe as > >
> > possible? > > > > > > > ****
> >  **********Ideas to please picky eaters. Watch
> video on AOL Living. > (
> >
>
http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/>
> > 2050827?NCID=aolcmp00300000002598)> -->
> trauma-list : TRAUMA.ORG> To
> > change your settings or unsubscribe visit:>
> > http://www.trauma.org/index.php?/community/
> >
>
_________________________________________________________________
> > Shed those extra pounds with MSN and The Biggest
> Loser!
> > http://biggestloser.msn.com/
> >
> > ------------------------------
> >
> > Message: 6
> > Date: Mon, 25 Feb 2008 10:17:20 -0500
> > From: "Ronald Gross" <Rgross at harthosp.org>
> > Subject: Re: "CATopsy" - postmortem CT.
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID: <47C295B0.7FF1.00B9.0 at harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > That would be ideal, but - and I hate to sound
> like this - who is going to
> > pay the cost of said CT postmortem exam?
> >
> > Ron
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 9:26 AM >>>
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext  |  PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > 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..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > -----Inline Attachment Follows-----
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > 
>
____________________________________________________________________________________
> > Be a better friend, newshound, and
> > know-it-all with Yahoo! Mobile.  Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> > ------------------------------
> >
> > Message: 7
> > Date: Mon, 25 Feb 2008 16:58:46 +0100
> > From: "aktham yaghi" <yaktham at gmail.com>
> > Subject: Re: cause of hypotension in shock/trauma
> > To: "Trauma &amp, Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> >       
>
<6de4dcb40802250758v7e430687l953aa63a15c80e4a at mail.gmail.com>
> > Content-Type: text/plain; charset=ISO-8859-1
> >
> > Ivan
> > Then
> > My question is why do you see bradycrdia with
> hypotension in spinal
> > anaesthesia (Lumber L2-3) not due to the dose of
> local anaesthetics?
> > Aktham Yaghi MD
> > FNsP, Bratislava, Ruzinov- ICU- KAIM
> > Clinic of Anaesthesia and Intensive Care Medicine
> > Comenius University,Faculty of Medicine
> > Ruzinovska 6
> > 82606 Bratislava
> > Slovak Republic
> > yaktham at gmail.com
> >
> > 2008/2/24 IVAN HRONEK <ih7 at msn.com>:
> >
> > > Neurogenic shock is hypotension with or without
> bradycardia - depending
> > on
> > > the cause - in high spinal cord lesions they
> will be bradycardic as to
> > the
> > > interruption of cardiac sympathetic
> accelerators. In neurogenic shock
> > due to
> > > brain lesion or thoracic spine injury the
> bradycardia is not necessarily
> > > present. The term is "relative bradycardia" i.e.
> heart rate not
> > > appropriate to the degree of hypotension ..which
> your patient actually
> > could
> > > be told to have - a HR of 110/min in a young man
> with a barely palpable
> > > pulse is certainly not a high enough reflex
> heart rate, you'd expect at
> > > least 140 / min or so.
> > > The problem with teaching about shock is that
> the bradycardia is the one
> > > thing one can easily remember about spinal shock
> - however, it does not
> > have
> > > to be present and then everyone is surprised.
> > > As dr. M. would say, a gentle clinician's touch
> is required here - this
> > is
> > > the time to use it  - the diff.dg is clinical
> and that is whether or not
> > > the patient's skin is cold and clammy or warm
> and dry - hypovolemic vs.
> > > neurogenic shock.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > Patients with neurogenic shock are hypotensive
> and usually have warm,
> > dry
> > > skin.8 Bradycardia is characteristic but not
> universal.
> > >
> ...www.accessmedicine.com/content.aspx?aID=588768 -
> Similar pages
> > >
> > >
> > >
> >
> >
> > ------------------------------
> >
> > Message: 8
> > Date: Mon, 25 Feb 2008 11:05:19 -0500
> > From: "Ronald Gross" <Rgross at harthosp.org>
> > Subject: RE: (no subject)
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID: <47C2A0EF.7FF1.00B9.0 at harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > The short answer is yes.
> >
> > >>> Anthony Caruso <medic541 at hotmail.com>
> 2/25/2008 9:42 AM >>>
> >
> > Just curious, but do these patients with cord
> compromise respond well to
> > certain types of catecholamine infusions????
> >
> > Anthony Caruso EMT-P
> >
> >
> >
> > > From: KMATTOX at aol.com> Date: Sun, 24 Feb 2008
> 22:09:22 -0500> To:
> > trauma-list at trauma.org; RUTLEDGELEGALRN at aol.com>
> CC: > Subject: Re: (no
> > subject)> > Which case are you referring to
> specifically. We now know that >
> > prehospital fluids more times than not are a
> DETRIMENT to survival. You do
> > not usually > "but time" by infusing fluids,
> unless the BP is below 50/- and
> > one cannot > feel a peripheral pulse. If there is
> a pericardial tear, then
> > change in > position is a better option than
> giving fluids and drugs in the
> > ambulance. > AND paramedics should most of the
> time NOT put tubes and
> > needles into a > chest. . I feel more strongly
> AGAINST interosseous needles
> > in the EMS setting. > > > k> > > In a message
> dated 2/24/2008 9:01:18 P.M.
> > Central Standard Time, > RUTLEDGELEGALRN at aol.com
> writes:> > This case
> > fascinates me. Would the initial resusitation with
> IVF's buy time > > as it
> > appears happened in this patient's case, in the
> events you describe as > >
> > possible? > > > > > > > ****
> >  **********Ideas to please picky eaters. Watch
> video on AOL Living. > (
> >
>
http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/>
> > 2050827?NCID=aolcmp00300000002598)> -->
> trauma-list : TRAUMA.ORG> To
> > change your settings or unsubscribe visit:>
> > http://www.trauma.org/index.php?/community/
> >
>
_________________________________________________________________
> > Shed those extra pounds with MSN and The Biggest
> Loser!
> > http://biggestloser.msn.com/--
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > ------------------------------
> >
> > Message: 9
> > Date: Mon, 25 Feb 2008 13:12:45 -0500
> > From: "William Bromberg"
> <brombwi1 at memorialhealth.com>
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> > To: <trauma-list at trauma.org>
> > Message-ID:
> <47C2BED1.85AB.003A.0 at memorialhealth.com>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > Man, you're lucky. Chatham county runs out of
> money allocated for post
> > mortems by April. After that you only get PMs on
> people who die outside the
> > hospital in a manner that may be criminal. The
> hospital won't pay either.
> >
> >
> >
> > >>> "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
> 02/25/2008 7:50 AM >>>
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > 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..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > ------------------------------
> >
> > Message: 10
> > Date: Mon, 25 Feb 2008 14:06:11 -0800 (PST)
> > From: Ivan Hronek <ivanhronek at yahoo.com>
> > Subject: Re: "CATopsy" - postmortem CT.
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID:
> <362560.66922.qm at web62302.mail.re1.yahoo.com>
> > Content-Type: text/plain; charset=us-ascii
> >
> > the hospital will have to swallow the costs -
> there's not that many sudden
> > deaths that need to be explained and not all of
> them would get the CT scan.
> > It would be a great source of quality imrpovement
> and education - in the
> > paper they found esophageal intubation - imagine
> that !
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: Ronald Gross <Rgross at harthosp.org>
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Sent: Monday, February 25, 2008 7:17:20 AM
> > Subject: Re: "CATopsy" - postmortem CT.
> >
> > That would be ideal, but - and I hate to sound
> like this - who is going to
> > pay the cost of said CT postmortem exam?
> >
> > Ron
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 9:26 AM >>>
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext  |  PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > 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..."
> >
> >
> >
> > "Scripps Information Security"
> >
> >
>
------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may
> contain privileged and
> > confidential information and are intended solely
> for the use of the
> > individual or entity to which they are addressed.
> If you are not the
> > intended recipient or the person responsible for
> delivering the e-mail to
> > the intended recipient, you are hereby notified
> that any dissemination or
> > copying of this e-mail or any of its attachment(s)
> is strictly prohibited.
> > If you have received this e-mail in error, please
> immediately notify the
> > sending individual or entity by e-mail and
> permanently delete the original
> > e-mail and attachment(s) from your computer
> system. Thank you for your
> > cooperation.
> >
> >
> >
> >
>
==============================================================================
> >
> >
> >
> > -----Inline Attachment Follows-----
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > 
>
____________________________________________________________________________________
> > Be a better friend, newshound, and
> > know-it-all with Yahoo! Mobile.  Try it now.
> >
>
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
> > --
> > 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/
> >
> >
> >
> > 
>
____________________________________________________________________________________
> > Never miss a thing.  Make Yahoo your home page.
> > http://www.yahoo.com/r/hs
> >
> > ------------------------------
> >
> > Message: 11
> > Date: Mon, 25 Feb 2008 14:35:24 -0800 (PST)
> > From: Ivan Hronek <ivanhronek at yahoo.com>
> > Subject: etiology of bradycardia in spinal
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Cc: Anesthideas at yahoogroups.com
> > Message-ID:
> <98250.9189.qm at web62309.mail.re1.yahoo.com>
> > Content-Type: text/plain; charset=iso-8859-7
> >
> > That's all I got Yaghi..
> >
> > Summary
> > While many factors can contribute to cardiac
> arrest during spinal
> > anesthesia, vagal responses to hypovolemia often
> play a key role. It is well
> > established that vagal responses can be triggered
> by decreases in preload.
> > JB Pollard, Stanford.
> >
>
http://www.apsf.org/resource_center/newsletter/2001/fall/04cardiac.htm
> >
> >
> >
> > It is postulated that the etiology
> > of the bradycardia and asystole might be
> > a reflex mechanism such as the Bezold-Jarisch
> > reflex (4). H.Hyderally, Mt. Sinai J Med. 1/2
> 2002.
> >
> http://www.mssm.edu/msjournal/69/v69_1&2_055_056.pdf
> >
> >
> > High levels of spinal or epidural blockade can
> produce severe hypotension.
> > In a review of closed claims of patients who
> suffered perioperative cardiac
> > arrest, a series of cases were identified that
> involved generally healthy
> > patients undergoing spinal anesthesia.[178] Common
> features of these cases
> > and subsequent case series[179] included high
> dermatomal levels of spinal
> > anesthesia, liberal use of sedatives, and
> hypotension accompanied by
> > bradycardia. The authors noted that adverse
> outcomes seemed to be associated
> > with delays in recognition of the problem, delays
> in instituting airway
> > support (particularly in sedated patients), and
> delays in administration of
> > direct-acting combined á- and â-adrenergic
> agonists such as epinephrine.
> > Although mild degrees of hypotension generally
> respond well to
> > indirect-acting sympathomimetics such as ephedrine
> or incremental dosing of
> > phenylephrine, the combination of severe
> hypotension and significant
> > bradycardia under
> >  spinal anesthesia should in most clinical
> settings be treated promptly
> > with incremental dosing of epinephrine.
> > (Miller textbook)
> >
> > When properly conducted, spinal anesthesia has
> proved to be extremely
> > safe. Caplan and associates[109] identified 14
> cases of sudden cardiac
> > arrest in healthy patients receiving spinal
> anesthesia. Because these cases
> > seemed to appear suddenly after stable hemodynamic
> status, they concluded
> > that a poorly understood potential exists for
> sudden cardiac arrest in
> > healthy patients. It can be debated whether this
> represented a lack of
> > vigilant monitoring and treatment as opposed to
> some mysterious physiologic
> > explanation.[128] It is clear that hypoxemia and
> oversedation are not
> > required for severe bradycardia and asystole to
> develop during
> > well-conducted spinal anesthesia.[49][129]
> Likewise, it is clear that the
> > development of severe brady-cardia after spinal
> anesthesia is not a new
> > phenomenon but has been recognized for many
> years.[130][131] In any case, it
> > should be emphasized that cardiovascular changes
> can occur rather suddenly
> > after spinal anesthesia, and
> >  as Auroy and colleagues[114] highlight, these
> events continue to occur.
> > (Miller textbook)
> >
> >
> > 128. Zornow MH, Scheller MS: Cardiac arrest during
> spinal anesthesia
> > [letter].  Anesthesiology  1988; 68:970.
> > 129. Mackey DC, Carpenter RL, Thompson GE, et al:
> Bradycardia and asystole
> > during spinal anesthesia: A report of three cases
> without morbidity.
> >  Anesthesiology  1989; 70:866.
> > 130. Thompson KW: Fatalities from spinal
> anesthesia.  Anesth Analg  1934;
> > 13:75.
> > 131. Wetstone DL, Wong KC: Sinus bradycardia and
> asystole during spinal
> > anesthesia.  Anesthesiology  1974; 41:87.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
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> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: aktham yaghi <yaktham at gmail.com>
> > To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org>
> > Sent: Monday, February 25, 2008 7:58:46 AM
> > Subject: Re: cause of hypotension in shock/trauma
> >
> > Ivan
> > Then
> > My question is why do you see bradycrdia with
> hypotension in spinal
> > anaesthesia (Lumber L2-3) not due to the dose of
> local anaesthetics?
> > Aktham Yaghi MD
> > FNsP, Bratislava, Ruzinov- ICU- KAIM
> > Clinic of Anaesthesia and Intensive Care Medicine
> > Comenius University,Faculty of Medicine
> > Ruzinovska 6
> > 82606 Bratislava
> > Slovak Republic
> > yaktham at gmail.com
> >
> > 2008/2/24 IVAN HRONEK <ih7 at msn.com>:
> >
> > > Neurogenic shock is hypotension with or without
> bradycardia - depending
> > on
> > > the cause - in high spinal cord lesions they
> will be bradycardic as to
> > the
> > > interruption of cardiac sympathetic
> accelerators. In neurogenic shock
> > due to
> > > brain lesion or thoracic spine injury the
> bradycardia is not necessarily
> > > present. The term is "relative bradycardia" i.e.
> heart rate not
> > > appropriate to the degree of hypotension ..which
> your patient actually
> > could
> > > be told to have - a HR of 110/min in a young man
> with a barely palpable
> > > pulse is certainly not a high enough reflex
> heart rate, you'd expect at
> > > least 140 / min or so.
> > > The problem with teaching about shock is that
> the bradycardia is the one
> > > thing one can easily remember about spinal shock
> - however, it does not
> > have
> > > to be present and then everyone is surprised.
> > > As dr. M. would say, a gentle clinician's touch
> is required here - this
> > is
> > > the time to use it  - the diff.dg is clinical
> and that is whether or not
> > > the patient's skin is cold and clammy or warm
> and dry - hypovolemic vs.
> > > neurogenic shock.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > Patients with neurogenic shock are hypotensive
> and usually have warm,
> > dry
> > > skin.8 Bradycardia is characteristic but not
> universal.
> > >
> ...www.accessmedicine.com/content.aspx?aID=588768 -
> Similar pages
> > >
> > >
> > >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > 
>
____________________________________________________________________________________
> > Be a better friend, newshound, and
> > know-it-all with Yahoo! Mobile.  Try it now.
> >
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> >
> >
> > ------------------------------
> >
> > Message: 12
> > Date: Tue, 26 Feb 2008 06:46:22 -0500
> > From: "Ronald Gross" <Rgross at harthosp.org>
> > Subject: Re: "CATopsy" - postmortem CT.
> > To: "Trauma &amp; Critical Care mailing list"
> <trauma-list at trauma.org>
> > Message-ID: <47C3B5BE.7FF1.00B9.0 at harthosp.org>
> > Content-Type: text/plain; charset=US-ASCII
> >
> > >>"the hospital will have to swallow the costs"<<
> > I want to work where you work.  Some hospitals
> balk at paying physician
> > salaries because there are some folks that don't
> understand why, in a Level
> > I trauma center, the docs have to get paid even if
> they aren't seeing
> > patients the entire time they are in house.  So,
> do you think they would pay
> > the cost of a procedure that won't help the bottom
> line????
> >
> > Good luck with that one,
> > Ron
> >
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 5:06 PM >>>
> > the hospital will have to swallow the costs -
> there's not that many sudden
> > deaths that need to be explained and not all of
> them would get the CT scan.
> > It would be a great source of quality imrpovement
> and education - in the
> > paper they found esophageal intubation - imagine
> that !
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: Ronald Gross <Rgross at harthosp.org>
> > To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org>
> > Sent: Monday, February 25, 2008 7:17:20 AM
> > Subject: Re: "CATopsy" - postmortem CT.
> >
> > That would be ideal, but - and I hate to sound
> like this - who is going to
> > pay the cost of said CT postmortem exam?
> >
> > Ron
> >
> > >>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008
> 9:26 AM >>>
> > Any way to instititute CATopsy - that would be
> great self-education -
> > immediately learning the cause of death !
> > We rarely are allowed to do any autopsies and then
> when the results come 8
> > months later noone remembers the case anymore.
> >
> > Fulltext  |  PDF (558 K)
> > Postmortem Computed Tomography, "CATopsy",
> Predicts Cause of Death in
> > Trauma Patients.
> >
> > Original Articles
> > Journal of Trauma-Injury Infection & Critical
> Care. 63(5):979-986,
> > November 2007.
> > Hoey, Brian A. MD; Cipolla, James MD; Grossman,
> Michael D. MD; McQuay,
> > Nathaniel MD; Shukla, Pratik R. MD; Stawicki,
> Stanislaw P. MD; Stehly,
> > Christy BS; Hoff, William S. MD
> > Abstract:
> > Background: The autopsy remains the gold standard
> for evaluating traumatic
> > deaths. The number of autopsies performed has
> declined dramatically. This
> > study examines whether postmortem computed
> tomography ("CATopsy") can be
> > used to determine cause of death in trauma
> patients.
> > Methods: Patients who presented to the trauma
> service and subsequently
> > died within the first 24 hours of their
> hospitalization were prospectively
> > enrolled. Any patient who underwent a major
> invasive procedure within this
> > time frame was excluded. After pronouncement of
> death, each patient had a
> > CATopsy performed, which was a noncontrast whole
> body scan. The patient then
> > underwent an autopsy. These results were compared
> with those generated by
> > the CATopsy.
> > Results: There were 12 patients enrolled in the
> study; average Injury
> > Severity Scores was 33.5 +/- 19.0. In 10 of the 12
> cases (83%), the
> > CATopsy successfully indicated cause of death when
> compared with the
> > autopsy. Seven of the 12 (58%) CATopsies
> demonstrated air in various parts
> > of the circulatory system, including the heart in
> four cases. Five of the 12
> > (42%) patients had clinically significant findings
> (including the presence
> > of an esophageal intubation) noted on the CATopsy
> not previously identified
> > on any radiographic studies or on the autopsy.
> These findings were addressed
> > as part of our performance improvement process.
> > Conclusion: This study suggests that a postmortem
> imaging test, a CATopsy,
> > can be used to determine cause of death in trauma
> patients. Beyond offering
> > a noninvasive alternative to autopsy, it provides
> similar information to
> > that provided in postmortem examination and may be
> used in trauma
> > performance improvement activities.
> >
> > Ivan Hronek MD
> > SFMC, Los Angeles
> > cell: 310 487-3288
> > http://health.groups.yahoo.com/group/Anesthideas/
> > Don't fight darkness. Bring the light, and
> darkness will disappear.
> > Maharishi Mahesh Yogi
> >
> >
> >
> > Confidentiality Notice: This transmission and any
> attached documents may
> > be confidential and contain information protected
> by State and Federal
> > Medical Privacy statutes and is legally
> privileged. They are intended for
> > use only by the addressee. If you are not the
> intended recipient of this
> > transmission, or an agent of the intended
> recipient, you are prohibited from
> > reading, disclosing, printing, saving, copying,
> using, or otherwise
> > disseminating any information contained in this
> transmission. If you
> > received this transmission in error, please accept
> our apologies and notify
> > me at  ivanhronek at yahoo.com and delete the entire
> message and its
> > attachments. Thank you. Disclaimer: this message
> contains the personal views
> > of the author. The author will not be responsible
> in any way for procedures
> > or approaches perfomed in the way suggested in
> this note.
> >
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org>
> > To: trauma-list at trauma.org
> > Sent: Monday, February 25, 2008 4:50:18 AM
> > Subject: RE: trauma-list Digest, Vol 56, Issue 28
> >
> > This case re-emphasizes the importance of
> post-mortem examination
> > following every death from injury. Even the most
> aggressive and
> > comprehensive pre-mortem CT or MRI imaging can
> substitute for the old
> > fashion autopsy. We can speculate until our next
> birthdays, there is no
> > answer without a post-mortem. In San Diego, we
> don't present our deaths to
> > our system wide Medical Audit Committee until the
> post-mortem results are
> > ready and a member of the County Medical
> Examiner's physician staff joins us
> > for the discussion.
> >
> > Mike Sise
> > San Diego
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of
> > trauma-list-request at trauma.org
> > Sent: Mon 2/25/2008 4:00 AM
> > To: trauma-list at trauma.org
> > Subject: trauma-list Digest, Vol 56, Issue 28
> >
> >
> >
> > Send trauma-list mailing list submissions to
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> 
> 
> 
> -- 
> Stephen L. Richey, CRT
> 
> "It is better to know some of the questions than all
> of the answers."- James
> Thurber
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Sanjay Gupta
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