interesting zone I GSW

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How much blood in the chest.? will likely need evacation of that.? One can bleed quite a bit from chest wall, intercostals or pulmonary lac. As the bleeding has stopped it is not likely emergency.? If there is significant blood i the chest you want to get rid of it to prevent long term fiborthorax or empyema.? you all so need to make sure the reason the "drainage stopped" is not because your tube is occluded. 


Rebecca Wolfer, MD, FACS, FCCP
Associate Professor, Marshall University School of Medicine
Dept of Surgery
Director Thoracic Surgery
Director, Surgical Critical Care Cabell Huntington Hospital
Director, Trauma Cabell Huntington Hospital


-----Original Message-----
From: SJASMD at aol.com
To: trauma-list at trauma.org
Sent: Mon, 5 May 2008 8:04 am
Subject: Re: interesting zone I GSW



 
In a message dated 5/4/2008 11:27:57 P.M. Eastern Standard Time,  
shebrain1 at yahoo.com writes:

I would  do very careful exam to R/O any other GSW to abd, to help explain 
his  hypotension which i think is due to hemorrhage and possible initial 
neurogenic  origin.

how about his LU pulse exam, any  difference? any bruit over supraclavicular 
region , any arm swelling, that  might suggest AVF with Hyperdynamic state 
that can explain his increased  BP.

the Chest Tube out put is 1600 ml Over how long  time? or better how  much 
over the last 2-3 hours?

if patient remained stable with decreasing CT out put, I would  obesrve, if 
any Q about integrity of aorta I would have IVUS to  evlaute.
I would admit to ICU, get EKG and possible TEE and  observe.unless become 
unstable.


ss


no other injuries
pulses symetrical
no bruit
no arm swelling
possibly over resuscitated to cause bp increase?
output was over about six hours. by end of angio, output stopped. still  
residual blood in the chest
ekg normal
currently being observed
 
would ken mattox do a CT of the chest after a negative angiogram?
 
sal



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