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Wed May 7 11:39:15 BST 2008

Tim and Ian,

I send the Grade I's & II's home in 48 hours if their VS remain normal and HCT doesn't change appreciably.  My bed managers and "damaged care companies" (aka managed care for those who haven't yet had the pleasure) would have a fit if I kept a Grade I or II in for 5 days with everything being normal......

I do agree with your "very clinical management" concept.  sorta remins me of the lost art of actually treating the patient, and not the numbers.    Hmmmmmm.

I'll shut up now - at my age, I tend to get a bit punchy after being up all night!  No 80 hour weeks for the wicked, you know!  ;-)

Ron

>>> "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za> 5/7/2008 6:09 AM >>>
Ian

Where I was previously (currently we only do ICU / HDU) we would put
them in our general ward (Trauma Only ward) and monitor Hb 4 hourly for
the first 48 hours. Grade was not a predictor, neither was heart rate or
BP. Stability was a combination of clinical factors. If they were OK by
day 5 - they went home. No follow-up CT, nor ultrasound. Very clinical
management.

I'm inclined to say that most people overtreat the non-op group; they
either do well and go home despite us or show clinical signs of failure
in the first few hours anyhow.

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ian Seppelt
Sent: 07 May 2008 08:50
To: trauma-list at trauma.org 
Subject: Blunt splenic injuries

Quick and dirty survey:

Where do you nurse haemodynamically stable patients with an isolated
spleen injury being managed conservatively, and no other injuries? ICU?
General ward? Higher acuity ward?
What acuity of nursing? What monitors? 
Does the exact CT grade of injury matter, or merely the fact that the
patient is stable and the trauma surgeon is comfortable to watch?

Many thanks,

Ian

correspondence to: seppelt at med.usyd.edu.au 

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

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Blunt splenic injuries