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Fri Jan 18 16:28:04 GMT 2008

Hi Mike:
Everyone does present differently with Guillian Barre because my  
step-father recalls the pain in his joints and severe cramping. He  
also stated that when the sensation was starting to return that it  
sometimes felt like needles. So for people to say all Guillian Barre  
patients do not have pain is not exactly true. I hope that helps, I  
have learned that the best experience is the one you have lived and  
that's why I went to him in hopes of clearing some of the  
misconceptions or text book cases that people often classify as the  
absolute. Have a great day and I hope that his experience might help  
us to have an open mind to other's experiences.
Respectfully,
Carol Eisenbrant R.N.

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> Today's Topics:
>
>    1. RE: HYPErthermia in sci (Robert Smith)
>    2. RE: a likely occurence? (Bjorn, Pret)
>    3. Re: GSW to liver  (khumar huseynova)
>    4. Re: GSW to liver (khumar huseynova)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Wed, 16 Jan 2008 07:10:17 -0600
> From: "Robert Smith" <rfsmithmd at comcast.net>
> Subject: RE: HYPErthermia in sci
> To: "'Trauma &amp; Critical Care mailing list'"
> 	<trauma-list at trauma.org>
> Message-ID: <000c01c85841$2940a4c0$7bc1ee40$@net>
> Content-Type: text/plain;	charset="us-ascii"
>
> http://select.nytimes.com/mem/tnt.html?_r=2&emc=tnt&tntget=2008/01/15/health
> /15spin.html&tntemail1=y&oref=slogin&oref=login
>
> f/u to the Kevin Everett story
>
>
>
> ------------------------------
>
> Message: 2
> Date: Wed, 16 Jan 2008 08:12:46 -0500
> From: "Bjorn, Pret" <pbjorn at emh.org>
> Subject: RE: a likely occurence?
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB267A at VALIER.me.emh.org>
> Content-Type: text/plain;	charset="us-ascii"
>
> Ah!  I KNEW somebody would find a trauma teaching point in all this...
>
> Very important insight, Dr. Coats.  Thanks.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Coats Tim -
> Professor of Emergency Medicine
> Sent: Wednesday, January 16, 2008 3:12 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: a likely occurence?
>
>
> Children with medical problems affecting limbs often give a history of
> trauma - because children are falling around every day so there is
> almost always an episode of minor trauma shortly before the symptoms
> started.
>
> A classic example is of septic arthritis of hip presenting with a
> history of trauma. The sequence of events is: 1) Child complains of a
> painful knee - due to the hip infection. 2) Parent asks 'Have you bumped
> it?'. 3) Child says they fell over playing football. 4) Doctor is told
> 'My child fell over playing football and his knee hurts'. 5) Doctor
> assumes that this is an injury takes an Xray of the knee and misses the
> diagnosis.
>
> My guess is that the history of a fall in the case that you present is
> completely un-connected with the symptoms.
>
> Tim. Coats.
> Professor of Emergency Medicine.
> Leicester, UK
>
>
>
> -----Original Message-----
> From: Mike Smertka [mailto:medic0947969 at yahoo.com]
> Sent: 16 January 2008 01:36
> To: Trauma &amp, Critical Care mailing list
> Subject: RE: a likely occurence?
>
> No i didn't call the discovery channel, I was just trying to make sense
> out of my little part while filling out discharge papers with what
> little info I was given. I couldn't remember the name guillian barre :(
> so thanks for reminding me.
>
>   Thanks all
>
>   Mike
>
> "Moore, Rick" <Rick.Moore at TriadHospitals.com> wrote:
>   Yes both would likely shed protein into the CSF. Transverse Myelitis
> fits due to the pain, but normally does not completely resolve. Guillian
> Barre normally doesn't cause pain or numbness but will completely
> resolve. Sounds like a good episode of Medical Incredible or Medical
> Detectives.
> Rick
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent: Tuesday, January 15, 2008 2:25 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: a likely occurence?
>
> Well, we agree on the "doubt trauma" part. I think any other guesses
> would be conditional or atypical, hence my decision to take a stab at it
> myself.
>
> Still, I would imagine that GBS -- or any flavor of myelitis -- would
> have probably shed protein into the CSF. Wouldn't it?
>
> Pret
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Moore, Rick
> Sent: Tuesday, January 15, 2008 2:01 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: a likely occurence?
>
>
> I discussed this with one of our ED physicians and his response is
> "Transverse Myelitis vs. Guillian Barre, doubt trauma".
> Rick Moore, RN
> College Station(Tx)Medical Center
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent: Tuesday, January 15, 2008 11:49 AM
> To: Trauma & Critical Care mailing list
> Subject: RE: a likely occurence?
>
> Disclaimer: Pret Bjorn is a nurse. And bolder than he is bright.
>
> Were all of her shots up to date?
>
> This is a soft mechanism and an odd story for trauma. I'd think central
> cord is a reach, especially if nothing lights up on her MRI.
>
> The medical differential (inasmuch as I pretend to understand it) isn't
> much more helpful. Gets into stuff like Guillian-Barre and polio -- and
> there again, this story is wanting for a good fit.
>
> Might have to settle for a good outcome in the absence of good answers.
> Have you called the Discovery Channel?
>
> Pret Bjorn
> Bangor, ME USA
>
>
>
>
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Mike Smertka
> Sent: Tuesday, January 15, 2008 12:26 PM
> To: Trauma &, Critical Care mailing list
> Subject: a likely occurence?
>
>
>
> Hey everyone,
>
> Today I was fortunate enough to be presented with a clinical issue
> rather than an academic one. But I have not seen anything like it before
> so I figure I would put it up for discussion. (before anyone asks, yes,
> I have heard of central cord syndrome, and I realize this sounds similar
> at a different location, that is why I am asking)
>
> 11 y/o female, pushed down at school, fell on full backpack. (weight
> unknown, estimate ~10 lbs) but was also ill at the time with flu like
> symptoms.
>
> Over a course of 7 days (at home and school), developed pain in lower
> legs, which advanced into lower sacral area, followed by complete loss
> of motor/sensation in lower extremities. was taken to an outlying
> facilty by parents. after failed attempts at LP was given antibiotics,
> antivirals, and transferred to facility here. (regional childrens
> center) after 2 days the LP was finally done and nothing abnormal was
> found. MRI showed soft tissue swelling, in the lumbar/sacral region. (I
> have no way to digitally scan the film or I would put it here) after
> another 11 days in hospital, function and sensory returned to lower
> extremities. Patient was discharged and complained of fatigue and muscle
> weakness but didn't want to stay any longer. Left hospital under her own
> power. (with parents of course)
>
> But my question is such:
>
> It sounds to me like this patient had some imparement because of soft
> tissue swelling pressing on the nervous or venous tissues. I was told
> the greatest fear was a viral infection that would recur and usually
> leaves permanant damage each time it does. (based on the flu-like
> symptoms and absence of brusing.)
>
> Ultimately neither was ruled in or out. has anyone seen either of these
> possibilities before? If so, how common is it? Is your first thought
> trauma or medical? Obviously there is the possibility of both, but
> having never seen it take 2 days to get an LP, I am of the mind it was
> most likely trauma related. here long hospital stays are not uncommon,
> but to see a patient walk out with only symptoms of fatigue, and
> localized weakness, seems very remarkable if it were a virus that causes
> permanant damage. The patient was referred to physical therapy, but it
> is doubtful she will go because of financial constraints and will
> probably be returning to her family physician for follow up. (a
> considerable distance away)
>
> Would appreciate your thoughts on the matter.
>
> Mike
>
>
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> ------------------------------
>
> Message: 3
> Date: Wed, 16 Jan 2008 16:59:41 -0500 (EST)
> From: khumar huseynova <khumarhuse at yahoo.ca>
> Subject: Re: GSW to liver
> To: trauma-list at trauma.org
> Message-ID: <153530.95621.qm at web32405.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> Well, there are no guilines for post-traumatic biliary leak   
> management, but  retrospective data support ERCP and stenting along   
> with perc drainage. Limited experience in our center (Toronto   
> Canada) supports it as well. No role for octreotide to reduce bile   
> leak.
>
>   KH
>
>
>
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> ------------------------------
>
> Message: 4
> Date: Wed, 16 Jan 2008 21:57:32 -0500 (EST)
> From: khumar huseynova <khumarhuse at yahoo.ca>
> Subject: Re: GSW to liver
> To: trauma-list at trauma.org
> Message-ID: <538931.77925.qm at web32405.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> About SW to anterior abdo and mgt of a hemodynamically stable pt...
>   We are currently doing a decision analysis on this. I have   
> reviewed the literature and there are basically no clearcut   
> guidelines as far as the management. For example, some centers elect  
>  to observe omental evisceration. Some decide to scan them. With   
> observation of stable pts, the rprobability of negative laparptomy   
> is about 0.2. CT on average has a sensitivity of 90%, specificity of  
>  75% and a NPV of 98%. Based on our prelim analysis, CT has no   
> advantage in terms of preventing complications (all kinds of) and   
> observation fairs better. In general, CT gives higer FN rates for   
> diaphragmatic and viscus injuries. Hospital stay is definitely   
> shorter with observation. Again, we are talking about a stable pt w   
> SWAAbdo.
>   KH
>
>
>
>
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