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Thu May 8 15:18:30 BST 2008

Nice case, 
Thank you for showing us.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of sjasmd at aol.com
Sent: Thursday, May 08, 2008 8:59 AM
To: trauma-list at trauma.org
Subject: Re: interesting zone I GSW

haim
in this case CT did not show the trajectory, did show known hematoma in
mediastinum as well as retained hemothorax. AND IT SHOWED AN INJURY NOT SEEN
ON ANGIO

with regard to the experience derved from this case:
1. don't over hydrate. it causes the aorta to bleed.
2. plus one for CT: i think it better visualized the injury

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 11:38 pm
Subject: RE: interesting zone I GSW

No evidence yet, but CTA in this case could show the tract, unseen hematomas
missed by the angio and also the damage to other structures. If the CTA
would show a suspected vessel damage, then depending of the kind of injury
either go directly to surgery or, as Dr. Mattox probably would want, confirm
with angio.

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: Tuesday, May 06, 2008 3:29 AM
To: trauma-list at trauma.org
Subject: Re: interesting zone I GSW

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 & 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