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Thu May 8 14:52:53 BST 2008

They would receive the usual triple vaccine for encapsulated organisms
(strep, haemophilus & meningococcal). They would receive this regardless as,
if conservative management were to fail, they would already by immunised
prior to their "delayed splenectomy." If conservative management is going to
fail, it usually fails early (within the first 24-48 hours.)

As Ron says, no evidence for when to return to contact sports etc. Despite
being told 3 months for grade I injuries, 4 months for grade II injuries and
6 months for higher grade injuries, many of the patients will nevertheless
ignore this advice and go back to full activities (including full contact
sports) much sooner than this.

Matthew

-----Original Message-----
From: nappio at aol.com [mailto:nappio at aol.com] 
Sent: 07 May 2008 19:39
To: Trauma &amp; Critical Care mailing list
Subject: Re: Blunt Splenic Injuries

What activities can they pursue and when?  Including rough sports.  Do you
give vaccines?  DN

Sent from my Verizon Wireless BlackBerry

-----Original Message-----

From: "Matthew Reeds" <mgreeds at reeds.uk.com>

Date: Wed, 7 May 2008 19:29:20 

To:"'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>

Subject: Blunt Splenic Injuries

If the patient is "stable" (translated to mean that the patient is not

having their "spleen preserved in a bucket") then, at least in our hospital,

they would be observed on the HDU for the first 24-48 hours. Like what used

to happen with Tim previously, grade is not a factor as to where they go as

there is not a "normal" dedicated trauma ward. If the patient shows no

clinical change after this time (they will have check Hb with HCT 12 hourly

- not 4 hourly like Tim's previous unit) and other vital signs remain

unchanged, then they get transferred to a general ward. I would not get

obsessed with specific observational readings such as BP & HR etc. - as it

is the patient's clinical condition that counts (treat the patient not the

numbers etc.) It is a change in the patient's vital signs that would warrant

reassessment of conservative management and not absolute values. After 2-4

days, if the patient remains well, they would be discharged home. Like Tim,

there is no further imaging or follow-up.

I agree with Ron that if transferring the patient to ITU is being

considered, then the patient is not "stable" and cannot be managed

conservatively (as the old saying goes - stable = a place for horses with

mess on the floor!!) In that case, I question the role for preserving the

spleen with angio rather than in a bucket. I also agree with Ron in that the

patient should not be transferred straight from the ED to ITU.

Matthew

-----Original Message-----

From: Ian Seppelt [mailto:seppeli at wahs.nsw.gov.au] 

Sent: 07 May 2008 07:50

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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