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Tue May 6 01:45:27 BST 2008

Let me make a prediction.      As presented this  patient has a descending 
thoracic aortic injury until proven  otherwise.     This one can come back to 
BITE you very  quickly.       The thick muscular wall of the  aorta can 
temporarily seal off and then just POP.     Be  careful, unless the CT for TRAJECTORY 
shows the path of the bullet to be totally  AWAY from the aorta.     

This case is a BIG TRAP

k

In a message dated 5/5/2008 7:29:28 P.M. Central Daylight Time,  
sjasmd at aol.com writes:

haim
sorry,let me try again

what is the evidence concerning  accuracy of CTA compared to the gold 
standard catheter based angiography for  penetrating trauma of the great  vessels?

sal

-----Original Message-----
From:  Dr. Haim Paran <paran620 at green.co.il>
To: 'Trauma &amp; Critical  Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 5 May 2008  1:40 pm
Subject: RE: interesting zone I GSW

I think I would  have started with a CT-angio in the first place.

Haim  Paran

-----Original Message-----
From:  trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On  Behalf Of SJASMD at aol.com
Sent: Monday, May 05, 2008 3:05 PM
To:  trauma-list at trauma.org
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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interesting zone I GSW