List Archives

Tue Mar 18 14:27:23 GMT 2008

One only does tests or procedures that change the outcome. Decompression will not effect the outcome. 

This patient needs resuscitation and operation.

Typed by the thumbs of
Norman on his BlackBerry 

Norman McSwain, MD
Tulane Univ Surgery
504 988-5111

----- Original Message -----
From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Tue Mar 18 01:23:52 2008
Subject: Re: NOt true trauma but a cool abdo case

Sounds very like a case we had last week. Colon perf by scope ( done  
at central london teaching hospital ). In your case I would have  
waited for the surgeon to come in, and not tried to decompress.  
Afterall, she now has the gas in the abdomen so the laparoscopy has  
started <g>
Nick
On 15 Mar 2008, at 17:12, Andrew J Bowman wrote:

> 55 year old female. PMH of L1 paraplegia from fall off roof 20 years  
> ago,
> paranoid schizophrenia.
>
> Had colonoscopy 2 days prior to ER visit for evaluation of "blood on  
> tissue
> paper".
> Patient does not know details of procedure. (biopsy, problems, etc)
> Presents with 2 days of increasing abdominal pain, bloating, nausea,
> anorexia and dyspnea and decreased urine output.
>
> Has not called her doctor or her GI doctor.
>
> I find her to be awake and alert. Tachypneic at 32, pulse 120-130,  
> BP 84/60.
> Abdomen rounded, bloated, firm, diffusely tender and has loud  
> tympany to
> percussion. Foley placed with
> 50ml urine returned. Breath sounds clear and equal, ? slightly  
> diminished.
>
> Fluid resuscitation started with NS. Stat acute abdomen series.
>
> Marked amount of free air with elevated diaphragm and downward and  
> medially
> displaced liver. Double colon wall sign noted.
>
> BP came up with fluids. Still tachypneic but maintaining sats with  
> nasal O2
> at 4lpm.
> Creatinine 2.5.
>
> I called surgeon and he came in about 45 minutes after call and off  
> to the
> OR about 30 minutes later (team is on call for this small community
> hospital). BP labile in ER waiting for surgeon. As low as mid-80's  
> and as
> high as 110 systolic. Heart rate always 110-120.
>
> Nice tension pneumoperitoneum with presumed abdominal compartment  
> syndrome.
>
> Should I have done a bedside decompression with a DPL catheter???
>
>
> Andrew
>
> I will have images to share by Tuesday am (if the computer Gods are  
> smiling)
> --
> 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/

List Archives

For your convenience, find the Trauma List Archive Below

NOt true trauma but a cool abdo case